OPHTE# 1a-s-aZP(,3? Harnett County Department of Public Health
PERMIT # Operation Permit 22365
2 -"New Installation 0 "'Septic Tank erNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Cc,v : /ess ~ 1DQJc1~µ e. SUBDIVISION F- oJ'142- on LOT #
System Installer: _ Ad c.c.x Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community 2'lublic ❑ Well Distance from well 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
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PERMIT CONDITIONS:
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 211
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the seewwsdisposal system on the above captioned property.
Type of system: ❑ Conventional 12' Other L -Fla
Subsurface No. of exact length
Drainage Field ditches of each ditch 6-Q feet
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: /00 0 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches J a 2 inches
French Drain Required: Linear feet
Authorized State Agen- Date z Z °
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