OPHTE# 5 ?,�o� Harnett County Department of Public Health
PERMIT # =���d� ODeration Permit 22546
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC D-
Name: (owner) �i ✓ C%-2rY-,3 C;�S 10 SUBDIVISION _1 _h0 G-,0 cs, r.s'E LOT # 133
System Installer: i5 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community 1K, Public ❑ Well Distance from well CC)® 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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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 ❑ NVIN
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E_— Low Septic Tank: 10 ® o
Subsurface No. of exact length width of
Drainage Field ditc of each ditch �1C feet ditches 3
French Drain Required: in
=aa5 Date
Authorized State Agent �� 1�
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches_ inches
13- 5,30-] q