OPHTE# \`-5-~ (0 Harnett County Department of Public Health
PERMIT # 0 eration Permit 22131
X~ New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C` PV-'4.S V'P
Name: (owner) OK"C~-2 SUBDIVISION LOT # a'~
System Installer: Registration #
Basement with plumbing: El Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community "R Public ❑ Well Distance from well @ 4 O feet
System Type: Z3 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, all conditions of the Improvement Permit and Construction Authorization.
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r~nrni V111U V113.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
IV. Operation:
V. Other:
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the above c ptioned operty.
Type of system: ❑ Conventional Other CNA cnS ~4" Septic Tank: l<e",® gallons Pump Tank: gallons
Subsurface No. of exact length _ width of depth of
Drainage Field ditches of each ditch -S feet ditches 3 feet ditches inches
French Drain Required: LineaT#eet
Authorized State Agent ~~y~ T~ V-G~ 6 Date _ ,1'-\I )
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