OPHTE# !ii~` Harnett County Department of Public Health
PERMIT #Operation Permit 22431
New Installation 'K Septic Tank )X Nitrification Line ❑ Repair ❑ Expansion
` PROPERTY LOCATION: C-f QQ-f S5 C~i y QCY
Name: (owner) '6oQ_Tonc lNA C_ SUBDIVISION C.-199.4-56 'Fns , , I, LOT # 2
System Installer: ~P~'SdrCt~t'SHG~aS Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community '19 Public ❑ Well Distance from well tab 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 Generpl 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.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Noll~
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 specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional °'r Other ~Ume 76 EZ~wow Septic Tank: 1P)00 gallons Pump Tank: 100 gallons
Subsurface exact length width of depth of
Drainage Field ditches of each ditch a30 feet ditches _ 3 feet ditches 1inches
French Drain Required: h~
Authorized State Agent ~yv r~ ~ 5 Date IaRw
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