OPHTE#►5-5-35-172, Harnett County Department of Public Health 23835
PERMIT # ��333 Operation Permit
New Installation '-V Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION:Vll, t -.ox,, 2ovC� V -P
Name: (owner) SUBDIVISION "aLit-yau3 JOT # 3`4fl
System Installer: Qrnixs sTn..ncy-x.ARegistration #
Basement with plumbing: ❑ Garage I Number of Bedrooms Lf -
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
This sniem has been installed in mmoliante with aoolicable Nonh Carolina General Shames. Rules for Sewaee Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
/ y r I oVSL
S7yr
/ d /
Type of system: El Conventional
X Other L 2— t_oW
/ a /
u
� N r
Pump Tank gallons
Subsurface No. of
Drainage Field .. ches
exact length
a. of each ditch Y OO feet
width of
ditches � feet
depth of ���
ditches _� inches
2
I
s Linear feet
V
�Tu6�
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Fallowing are the specifications for
the sewage disposal system the above captioned property.
Type of system: El Conventional
X Other L 2— t_oW
Septic Tank: WO gallons
Pump Tank gallons
Subsurface No. of
Drainage Field .. ches
exact length
a. of each ditch Y OO feet
width of
ditches � feet
depth of ���
ditches _� inches
French Drain Required
s Linear feet
Authorized State Aeent `4`- Date