OPHTE# 13 °" -3i 133 Harnett County Department of Public Health 23208
PERMIT # Z%4,--30 Operation _Pier it ^
[ New Installation L� Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5iUYi LOCATION: 7 6; «
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well feet
System Type: C f v �2 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
I L1u1n W11UMV11J.
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 ❑
Following are the Mclonventional cations for the sewage disposal system on the above captioned property.
Type of system: El Other
Subsurface No. of exact length --- >7-00
Drainage Field ditches of each ditch ° >? - feet
French Drain Required: Linear feet �:Q 2 t
Alarm ❑ H12OLine ❑ PWR Line
Septic Tank: (&,n gallons Pump Tank: gallons
width of 3 depth of �,Z
ditches feet ditches inches
Authorized State AveTft—)__ Date 15=- Z 3 °-
0 3/y7,7