OPHTE#,~~ ~~►~3 Harnett County Department of Public Health
PERMIT Operation Permit 2 2 7 3 9
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~-ANz 9,2
Name: (owner) C )-~Psg t.s` 5 Cu rte, SUBDIVISION LOT # -.d.--
System Installer: L e~t So' -\-`r~curG Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms '3
Type of Water Supply: ❑ Community N Public ❑ Well Distance from well 1®O feet
System Type: t5 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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:
No !AnT4Nc_
Oa 5, ; ~0 tt 0,j:-
*t ai
s°lna~1
r_1
D-Box ❑
Pump ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the speci
fications for the sewage disposal system on the above ca 'oned property.
Type of system: ❑
Conventional
Other C'~ Ni r'va t. L
Septic Tank: IQ Q) 1 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage field
di es 1~.
of each ditch feet
~y
ditches feet ditches d, \ inches
French Drain Required:
v
_ sd ' ear
Authorized State Agent _r*111 ~w v ~ .5 Date 3~8
F