OPNTE# 10-5- ~ Harnett County Department of Public Health
21863
PERMIT # '9L& 1 Operation Permit
New Installation ~ Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N~ ~a sss~ 94n
SUBDIVISION ~ fl ~n S
Name: (owner) LOT #
) Registration #
System Installer: Re
~.~c~~-~' g
Basement with plumbing: ❑ Garage Number of Bedrooms 5 feet
Type of Water Supply: ❑ Community Public ❑ Well Distance from well VC0
Types V and VI Systems expire in 5 years.
System Type:
(In accordance with Table V a) Owner must contact Health Department b months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for
Kid I-N
Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
~S dlo 9-(-,otx-r
ta.a
AQ-E'f~
T.
tp
1
I
10d x50
BOOS ~
S A T G
Ot
16U, ~WrAG
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
PWR Line
❑ D-Box ❑ Pump ❑ Alarm
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other V'--J
Subsurface No. of exact length
Drainage Field ditches of each ditch \ feet
French Drain Required: n ^ear f~
Authorized State
❑ Ff20Line ❑
Septic Tank: 1~.5 O gallons Pump Tank: gallons
width of depth of
3 feet ditches a>~°® inches
ditches
Date 1