OPHTE# 1-11-5-411643 Harnett County Department of Public Health 24899
PERMIT # a 56sZ Operation Permit
New Installation V Septic Tank V Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 69 Avaa-x E i rata i L
Name: (owner) 10-j aT%dry "onr-5, SUBDIVISION SZ, LOT #
System Installer: Epo,E 0— Registration Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms s-)
Type of Water Supply: ❑ Community ,� Public ❑ Well Distance from well feet
System Type: s a Types V and VI Systems expire in S years.
(In accordance with Table Y a) J Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been imaged in compliance with applicable North Carolina General sonnets, Rules for Sewage Treatment and Disposal, and all conditions of the Impmremem Permit and Construction Authorization
PERMIT CONDITIONS
I.
II.
III.
IV.
3'
AQI�A ( Ne�sG ( 10
ra
D1P qGt E �¢ry I._.
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
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.
Operation:
V. Other.
❑
D -Box ❑
Pump ❑ Alarm
❑ 112OLine ❑ PWR Line
er,
following are the specifications for the sewage disposal system on the above captioned property.�
Type of system: ❑
Conventional X Other
Ca -\A ret 9�L � F1g -,( t o/
Septic Tank: i 6ec gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage field
ditches
of each ditch I S'd feet
ditches 3 feet ditches Z%11r inches
French Drain Reouired:
Linear feet
Authorized State Agent sz� T45 Date
1-1- 5-2)� c X13