OPHTE# 11 -5aP-aw5I Harnett County Department of Public Health
PERMIT # ~-633y Operation Permit 21 9 7 8
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: h "LIC.S
Name: (owner) CJ N c_,Np;.y L4_ SUBDIVISION C ocean _ Fer~& LOT # S
System Installer: C37 ,5 `S> ~ g..jc. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 140 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 applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
i
t3~
WASEQ i 5ar
V,~~ linDsE
ARL Q.
R,
C
N PR,O)N 6 L-,N C=
PERMIT CONDITIONS:
1. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional K, Other L2- F-0 W Septic Tank: 1 Q O O gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches 4 of each ditch 50 feet ditches _ 3 feet ditches
French Drain Required: , Lm feet
PWR Line
gallons
inches
Authorized State Agent te~5 Date _ C
tit.
! E ~
G
Y k.
n ;
y
~
- I
I
_
_ 9
I
~
r
-
I
~ j
is
h
m
~
t
!5~
ten
I
y
{
r
t 1