OPHTE# -5~- Z6110 Harnett County Department of Public Health
PERMIT # Operation Pie Mlit 21729
New Installation LJ Seatic Tank /Nitrification Line ❑ Reaair ❑ Exoansion
PROPERTY LOCATION~z, W
Name: (owner) >AyMia-e x. 6tresc
SUBDIVISION LOT #
System Installer: (~1 Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: El Community L Public ❑ Well Distance from well feet
System Type: Z551a Z&i i s -7-4,3-M- C SOS' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) I Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewa¢e Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 th
e specifications for the sews
disposal system on the above captioned property.
Type of system:
❑ Conventional O
ther 2S IQ Zr-bQ(-
Septic Tank: 06 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches Z
of each ditch ! Z~ feet
ditches 3 feet ditches Zq" inches
French Drain Required: Linear feet
Authorized State A Date