OPHTE# 13— 5-'311Z -3 Harnett County Department of Public Health
PERMIT # ZI 38u Operation Permit 22988
LJ New Installation Er Septic Tank CD"'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:&A -j�p37 i3a,tto�,,Q
Name: (owner) .STAtje -t SUBDIVISION 1, ;.>r— LOT # 53
System Installer: 57eA)ez4 Registration #
Basement with plumbing: ❑ Garage 2"'Number of Bedrooms 3
Type of Water Supply: ❑ Community E2' Public ❑ Well Distance from we feet
System Type: ZS° t7fe, r i - c, Z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) ` Owner must contact ealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina Leral Statutes, Rules for Sewage Treatme t 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.
11. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional 13 Other Z%` /o Z P D v Septic Tank: 1 oa o gallons Pump Tank: gallons
Subsurface No. of c exact length Q width of depth of
Drainage Field ditches 1 of each ditch o C> feet ditches 3 feet ditches Z `( inches
French Drain Required: Linear feet
Authorized State A eTft �� - -� > l _ 11I 'q'k4'-S7 Date _ 10-11-1.s
13 -5 -31123 (1) 13 -5 -31123 (2) 13 -5 -31123 (3) 13 -5 -31123 (4) 13 -5 -31123 (5)
13 -5 -31123 (6) 13 -5 -31123 (7)