OPHTE# Harnett County Department of Public Health
PERMIT # a-sosC Operation Permit 21 6 3 5
New Installation X Septic Tank "4 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Ctz£~xSV~~E C~~ rrtLZt (L9
Name: (owner) SUBDIVISION SA~L~N dax LOT # 5
System Installer ZoN-"~ Q'C-s n;'C- a Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community 't5k Public ❑ Well Distance from well I o 0 feet
System Type: 7- ~ 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.
..n, ptem nas oeen mstauea to
with appluable North Carolina General Statutes, Rules for Sewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITION!-
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E Z F,_dw Septic Tank: 1 00 0 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch S feet ditches 3 feet ditches dP`21- inches
French Drain Reauired:
Authorized State Agent
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