OPHTE# 13-S-"31 Oi Harnett County Department of Public Health 23137
PERMIT # a�5 0 eration Permit
New Installation X Septic Tank < Nitrification Line ❑ Repair F-1 Expansion
PROPERTY LOCATION: i N GG N RO
Name: (owner) Asa L SUBDIVISION PA„oNs PolNT LOT #
System Installer: _r ac) '2S"w►Y Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: E-ep 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.
]his 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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PtKMII t.UNUIITUNS:
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 ❑ 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 sewage disposal system on the above
�a^ptionedproperty.
Type of system: ❑ Conventional )A
Other C�Ar�1 SC
�?y J Septic Tank: 1 ®0<J
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches
of each ditch
I feet ditches 3
feet ditches a.4 inches
French Drain Required: —"—"- -,
Linear feet
Authorized State Agent �QAZV Date a
3-,. ��