OPHTE# 13—s -3Zo19 Harnett County Department of Public Health 23351
PERMIT # 77 S 7 5 / Operation Per It
New Installation Septic Tank /Nitrification Line ❑ r Re ai ❑ Ex P ansion
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PROPERTY LOCATION: /,!y 7 A#--)Is c/1
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Name: (owner) SC—A Z CL SUBDIVISION ,� LOT # z
System Installer: Registration #
Basement with plumbing: ❑ Garage Zumber of Bedrooms
Type of Water Supply: El Community LJ Public ❑ Well Distance from well feet
System Type: 71r- G 9Z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) d lf Owner must cont ct Health Department 6 months prior to expiration for permit renewal.
Ihis 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.
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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewn a disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other Zr% jtr-W-rLe- 5K'� Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches y of each ditch J z. feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agett.,_,.� e /'li�� Date q-17 —jq
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