OP RHTE# 13-5 —319PS /Z Harnett County Department of Public Health
PERMIT # a��`9 o Operation —Perm t 23003
E� New Installation L3' Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /&,, y67^►
Name: (owner) J SUBDIVISION QCWZ7 LOT # f—v
System Installer: Registration #
Basement with plumbing: ❑ Garage Z' umber of Bedrooms 3
Type of Water Supply: ❑ Comm_u�m�( � Public ❑ Well Distance from well feet
System Type: Salo 'U �4r Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner Zust 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. / yd)
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 sewsrdisposal system on the above captioned property.
Type of system: ❑ Conventional L?J Other 2w> 5-66 -- Septic Tank: G0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 116 feet ditches 3 feet ditches a 0 — inches
French Drain Required: Linear feet
Authorized State Arent t 4---- t,,.., -(' Date a-
13- 5- 31905R (1)
13- 5- 31905R (2)
13- 5- 31905R (3)
13- 5- 31905R (4)
13- 5- 31905R (5)
13- 5- 31905R (6)
13- 5- 31905R (7)
13- 5- 31905R (8)
13- 5- 31905R (9)
13- 5- 31905R (11)
13- 5- 31905R (12)
13- 5- 31905R (13)
13- 5- 31905R (14)
13- 5- 31905R (10)