OPHTE# I &-5 5 - YbW6 Harnett County Department of Public Health 24624
PERMIT # 2L �Q eration Permi
New Installation 5,1eptic Tank nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ul 5 c -a 5 Ln ck- 'k ft Sn y�
Name: (owner) 0-.inA LOn"&L t -m" ine. SUBDIVISION A vnd LOT # 1-5
System Installer: Registration #
Basement with plumbing: ❑ Garage Ukluoiber of Bedrooms
Type of Water Supply: ❑ Community L9 -Public El Well Distance from well feet
System Type: 2 d: %" '575 • Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Sutures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No Zr
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OL1ne ❑ PWR Line
Following are the specifications for the sewage osal system on the above captioned pMperty.
Type of system: ❑ Conventional ElOther 25;= _L.(.L_S Septic Tank:ZI 5o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1-0 feet ditches 3 feet ditches '46 inches
French Drain Retained: Linear feet
Authorized State Agent Date