OPHTE# i 0-5--Di-S-1 Harnett County Department of Public Health
PERMIT # X63 Operation Permit 21 91 2
I New Installation 'A Septic Tank )K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M a2x~5
Name: (owner) ~~coE.~vG`7 1~om ~ SUBDIVISION As4~EFdas, LOT # Ql,~
System Installer: tiro sJ Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community ~K Public ❑ Well Distance from well L00 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.
This system has been installed in compliance with applicable North Carolina General ltatutes, Nules for sewage Ireatment and msposal, and an conaitnons of the improvement rermtt ana Lonstrucnon Autnorization.
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned roperty.
Type of system: ❑ Conventional Other C-, Aws6 6r2.. c QIA Septic Tank: 100® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field -~itthes of each ditch S C~ feet ditches 3 feet ditches inches
French Drain Reauired _ Lin net
Authorized State Agent {L,EINs Date
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