OPHTE #—\ L4 — 5--5A Harnett (ounty Department of Public Health 2366-2
PERMIT # OlDeration Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: kc.v�syc;�»� Qu2,G-j i-Ij
Name: (owner) `� j � � 2y gv t act SUBDIVISION744»V-6 SAN 0 r. f, LOT # 33
System Installer: 1 k o< -z, -z o N-5 Registration #
Basement with plumbing: ❑ Garage )5< Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well � dQ feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ihis system has been installed in,Eompliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 1`12O1-ine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: i4D�% gallons Pump Tank:
SubsurfaceNo. of exact length width of depth of
Drainage Field s � of each ditch �' a feet ditches feet ditches
French Drain Required: Linear feet
Authorized State Agent �� ����1 Date
PWR Line
gallons
inches
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