OPHTE# ( G -5-4020 Harnett County Department of Public Health 24599
PERMIT # ;Lc\ Operation Permit
:fQ New Installation Septic Tank X Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PMcfloe yqp Ry
Name: (owner) N,FeZ SUBDIVISION LOT #
System Installer: 5rw,o.9E Registration #
Basement with plumbing: ❑ Garage i66 Number of Bedrooms 4
Type of Water Supply: ❑ Community "X Public ❑ Well Distance from well 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.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
CT -LA -4
Q. 6��S(2—
s 8 y
,y Hous[ �2
E
McQaV ow
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 ❑ H2OLine
❑ PWR Line
Following are the
specifications for the sewage disposal s tem on the above captioned property.
Type of system:
El Conventional Other r -Z
'i"LPvy
Septic Tank: it") () 0 gallons
Pump Tank: gallons
Subsurface
Dramage-liel
No. ofY2
ditches
exact length
of each ditch '9-. 6— feet
width of
ditches feet
depth of
ditches inches
French Drain RoLitfd: Linear
feet
Authorized State Agent Date
C �.">- ��
\ �`�;�
N,