OPHTE# .13— -3z Harnett County Department of Public Health 23322
PERMIT # Ze`a 8J Operation Pe, rmit
L2' New Installation LJ Septic Tank C2' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION 40 :2 z pet 1W
Name: (owner) %1 ) I AV " SUBDIVISION /:6221? � P7— LOT #
System Installer: a Registration #
Basement with plumbing: ❑ Garage L'I Number of Bedrooms Sf57L-
Type of Water Supply: ❑ Community E�r`Public ❑ Well Distance from well feet
System Type: e'5`Yc a _ 6-- ` r OL TI'S ' 6,- 2t C. ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contac ealth 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
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 s a disposal system on the above captioned property.
Type of system: El Conventional ewa Other 75 %, ,' j)y c4 � j �cr. Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 90 feet ditches 3 feet ditches inches
French Drain Reauired: Linear feet
Authorized State Agony tZ Date
13 -5 -32307 (2) 13 -5 -32307 (3) 13 -5 -32307 (4) 13 -5 -32307 (5) 13 -5 -32307 (6)
13 -5 -32307 (7) 13 -5 -32307 (1)