OPHTE# II- '27'~ X56 ) Harnett County Department of Public Health
PERMIT # Neration Permit 2 2 4 2 3
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 7-imr.EN f-D
Name: (owner) tea,., c,•t +~~vo~.QS OH c.. SUBDIVISION Qa-;~o>ys Qo~ a LOT # W3
System Installer: -S ; a c.' t Registration #
Basement with plumbing: ❑ Garage `$'4 Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10Q 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 been installed in compliance with applicable North larohna beneral )tatutes, Rules for )ewage Ireatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
PtKMII LUNUMUM:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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:
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional X Other Z glow Septic Tank: X00 ® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 5 feet ditches 3~inches
French Drain Reauired: ~ 1~ 31-~i-Mar feet
Authorized State Agent nt~~.~ u--w Date - JL "I--
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