OPHTE#Harnett County Department of Public Health
PERMIT # Operation Permit 22419
New Installation _X Septic Tank V Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION k~~cNt,~~ LOT # N (6_
System Installer: 1Aa,< Lv) SFe-S tL Registration #
Basement with plumbing: ❑ Garage 'It< Number of Bedrooms Li
L Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well L~C7 feet
System Type: 7. 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 Uisposat, and an conditions of the improvement rermit and Construction Autnonzanon.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ ID-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1 ~ ~i w Septic Tank: 10®0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
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Drainage field ditches of each ditch feet ditches feet ditches inches
French-Drain Required: r feet _rz X, Authorized State Agent tt~ Date F 1
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