OPHTE# 1� 3a—� )3 Harnett County Department of Public Health 23384
PERMIT # �"� 0 eration Permit
New Installation Septic Tank,% Nitrificaf Line E:1Repair ElExpansion
PROPERTY LOCATION: o NN1es'Lz �
Name: (owner) 1;>,,i;,/_ �Aa mW SUBDIVISION GP�-L a LA NV>, LOT #'1-5
System Installer: r,3 A C n� Et? S `c— Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3'
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ie.?o feet
System Type: .Ll_ 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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PLKMII LUNDIIIUM:
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 ❑ N
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 captioned property.
Type of system: ❑ Conventional X Other 9xi-nQ �o C,1�4-,tc',s a— Septic Tank: t00 Q gallons Pump Tank: t6C50 gallons
Subsurface No. o exact length width of depth of
Drainage Field ditches of each ditch 1%0 feet ditches 3 feet ditches Q,„ -30 inches
French Drain Reouired`, '-� � Line feet
Authorized State Agent � -_-, \ Nl�_ '4��5 Date