OPHTE # Harnett County Department of Public Health
PERMIT # `5 Operation Permit 22858
New Installation X Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION: Q)L;oLl2.1
Name: (owner) EM 'N4- !,mp x_ SUBDIVISION TP 7Ez LOT # `3,4
System Installer: !^.,;.ca rLzj ",) K_ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community '>� Public ❑ Well Distance from well ate' 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 instaueo in compliance with applicable north t.arolma beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
rtnrll l I.UIYUI I11JINY
I. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ,K Other Vi_y .l Septic Tank: IQ 00 gallons Pump Tank: gallons
Subsurface No of exact length width of depth of
Drainage Field ditche -.'I of each ditch �i d feet ditches feet ditches inches
French Drain Required: —',,k, -Lio&feet
Authorized State Agent �v Date -7 111