OPHTE #J S_ Harnett County Department of Public Health 23733
PERMIT aeration Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t 1,-IG6-tj 'gyp
Name: (owner) k) SUBDIVISION �4 LOT #
System Installer: .c_ 11-s— c ttv6.n5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 14- -r
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: 1 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.
Ims system has Deen installed in compliance with applicable North Carolina heneral )tatutes, rules for )ewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PEKMII CUNVIIIUNS:
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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E `Z_ V%_ 61W Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch tC) feet ditches feet ditches a"—X inches
French Drain Reauired: —, I- t
Authorized State Agent Date -7/361 )3;'