OPHTE# , ~ - 5 aI(-`1 ~ ) Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 7 0 8
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ScQN 6
Name: (owner) NJseaA-Np,~L-4- -NoSnk,~ SUBDIVISION ~,~2b~,HA, S PSoN~ LOT # 114
System Installer: 1-As,~Lo Cx t z%Z- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1'64 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.
ims system nas peen mstauea in compuance witn appucanle north tarouna beneral xatutes, rules Tor )ewage Treatment and ulsposal, and all conditions of the improvement Permit and Construction Authorization.
rtKMII t.UNUIIIUN):
1. 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 ❑ H20Line ❑
Following are the speci
fications for
the sewage disposal s stem on the above captioned property.
Type of system: ❑
Conventional
Other 2. r~ww
Septic Tank: 1®DO gallons Pump Tank:
Subsurface
No. of
exact length
'
width of depth of
Drainage Field
ditches
7S feet
of each ditch
ditches 3 feet ditches
French Drain Reauired:
e
~t
PWR Line
gallons
inches
Authorized State A¢ent \~J\\v tc-"5 Date I b 1 1 011