OPHTE# —5 __� �j3� —1 Harnett County Department of Public Health
PERMIT # 0°1 D--7'0 Operation Permit 22510
} New Installation � Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: c. c A0
Name: (owner) C_f><Lc, -4, SA r,, SSsL-.c,G SUBDIVISION jGj-7 LOT # Q--
System Installer: C-,LvF. ,4r,�, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10(D 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 Ireatment and Disposal, and all conditions of me improvement rermtt am) construction mumorizauun.
N G'�\
PERMIT CONDITIONS:
I. 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>�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications
Type of system: ❑
for the sewage disposal system� on the above captioned property.
Conventional X Other E-2-
Septic Tank: 18Q) Q gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length
of each ditch feet
width of depth of
ditches feet ditches — inches
French ram Required: Linear feet
Authorized State Agent PS Date c�
1 �..- ��� ��`i3�,