OPHTE# 11-6__W J4 Harnett County Department of Public Health 24158
PERMIT # P 5q(3 Operation Permit/
4YNew Installation 2 Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: rltet k. 5j t413�
Name: (owner) ic. SUBDIVISION Tic oe LOT # _3
System Installer. Registration #
Basement with plumbing: ❑ Garage E;—W!�TABedrooms
Type of Water Supply: ❑ Community 2 -Public ❑ Well Distance from well 'A- feet
System Type: R,5 , s,5- 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 Statures, Rules for Sewage Treatment and Disposal, and all condmons of the Improvement Permit and Constmaion Authorisation
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 al system on the above captioned property.
Type of system:
El Other (y'c/ C 6snr�s Septic Tank I a Sv gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch IVy feet ditches 3 feet ditches �-'�1— cz inches
french Drain Required: linear feet
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