OPHTE# O9Harnett County Department of Public Health
PERMIT # a S\ Operation Permit 21 5 6 5
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: S,Erztit~ 2p,~1
Name: (owner) SNAC_0 Cam . LNC-. SUBDIVISION S~Eect P V~•L~cE LOT #
System Installer: Es~t.a E"PL-C. Registration #
Basement with plumbing: ❑ Garage'. Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1,0 G feet
System Type: 7;~j2 0. 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.
nos system nas peen mscanea in compuance win appucaoie north larolma beneral Statutes, Rules for kwage 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.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional X Other
T: Z Septic Tank: 1000
gallons Pump Tank gallons
Subsurface
No. of
exact length width of
depth of
Drainage field
ditches
of each ditch ao 0 feet ditches 3
feet ditches inches
French Drain Required:
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eel
Authorized State Agent \N'~ y Date 1 ~a~ ► b
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