OPHTE# Cam- 5-a1°3~ Harnett County Department of Public Health
PERMIT #Operation Permit 21625
New Installation "R Septic Tank X Nitrification Line El Repair 0 Expansion
PROPERTY LOCATION: N C,
Name: (owner) \Jjr4t,t C ~s~ctv~~oN SUBDIVISION -VIt-a ty ~o+r~E LOT # C-~-
System Installer: _ R-,PN,4P--/ ~~r► Registration #
Basement with plumbing. ❑ Garage "E< Humber of Bedrooms 3-
Type of Water Supply: ❑ Community Public ❑ Well Distance from well SSG feet
System Type: 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.
This system has been installed in compliance with applk" 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.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NOA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other poM'- Pu.r'a th S-T, -L ~ e 'a,E C.,,1 cFc~
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned pro rry.
Type of system: ❑ Conventional \X Other P u r~q t_-~ Septic Tank: 10 00 gallons Pump Tank: 1040 gallons
Subsurface exact length width of depth of
Drainage Field ditches \ of each ditch feet ditches 3 feet ditches I inches
French Drain Required: mPar_
Authorized State Agent S~ v~~~ sys Date 101 14\o
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