OPHTE# 12-5- -3 a 6-�r Harnett County Department of Public Health
PERMIT # off% a `tl Operation Permit 22580
New Installation Septic Tank Rf�N'trification Line ❑ Repair El Expansion
PROPERTY LOCATION: r-e1 T le')
Name: (owner) /Z -/4o-4 SUBDIVISION C V A LOT # 4T
System Installer: 3z'on /'I --f4,e wf Registration
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms r
Type of Water Supply: ❑ Community Z"'Public ❑ Well Distance from well feet
System Type: Cr 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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YtKMI I IUNUI I IUIVS:
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 ❑ No
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 sewa ,p disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other E 2— C /c,
Subsurface No. ter exact length
Drainage Field ditches of each ditch .780 feet
French Drain Reauired:
H2O1-ine ❑
PWR Line
Septic Tank: W-0 gallons Pump Tank: gallons
width of depth of
ditches —3 feet ditches /Z inches
Authorized State Agent �9 ,,-o Date S 11 ® 1 )3
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