OPHTE# 1'a"%-°PC~ i®l Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 2 2
New Installation IR Septic Tank Nitrification Line El Repair ❑ Expansion
PROPERTY LOCATION: ~1t2~z.~r+s4roN
Name: (owner) vs'S G k. L_ SUBDIVISION LOT # -8
System Installer: 0-T i S-~ Q.N c.-,.a. K"D Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public El Well Distance from well 1 O C~ 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
33 a:
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
Il. 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 the spec
ifications for the sewage dispo
sal system on the above captioned property.
Type of system: ❑
Conventional X<J,, Other
SZ F-pN Septic Tank: t000
gallons Pump Tank: gallons
Subsurface
No- °f
exact length width of
depth of
Drainage Field
ditches
of each ditch feet ditches 3
feet ditches 0 " of inches
French Drain Reauired:
Authorized State Agent RED Date 6
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