OPHTE# I J- 5 —41 f9 a Harnett County Department of Public Health 24833
PERMIT # -41681 5 eration Permit
New Installation eptic Tank La -I' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 135 More Cave .!s vci ti)
Name: (owner) `� kc�son Qa"1 —17r -x— SUBDIVISION yr o ra,u a LOT # G
System Installer: S'. Aac-� Registration #
Basement with plumbing: El Garage umber of Bedrooms 5�
Type of Water Supply: ❑ Community tic ❑ Well Distance from well �' feet
System Type: as% 14,d.+�6: 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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PERMIT CONDITIONS:
1. 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 17
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 system on the above captioned property.
Type of system: ❑ Conventional Ee—OtherT7, rr,a7 l Septic Tank gallons Pump Tank gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches oltU inches
trench Drain Required: Linear feet
Authorized State Agent Date
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