OPHTE# ia"',' 09'1l Harnett County Department of Public Health
PERMIT Operation Permit 22385
Q' New Installation L'Septic Tank L'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Al c- Qf 4
Name: (owner) %/4A Cow A—AJ C14' ten. SUBDIVISION 7-" � LOT # l V3
System Installer, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community k�— Public ❑ Well Distance from well feet
System Type: ?'1T' G- 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 aDDlicable North Carolina General Statutes. Rules for Sewage Treatment and Disposal. and all conditions of the Imnrnvement Permit and rnnstmrtinn Anthnri72tinn
MM11 LUNUIlIUN`t:
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 Rr
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 sews a disposal system on the above captioned property.
Type of system:
El Other CZ Flo LJ
Subsurface No. of exact length
Drainage Field ditches of each ditch_ feet
Alarm ❑ H2O1-ine ❑
PWR Line
Septic Tank: /CK) 0 gallons Pump Tank: gallons
width of depth of
ditches �✓ feet ditches inches
French Drain Required: Linear feet /
Authorized State Age c``� Date f G(�12G�2
r
1
MM11 LUNUIlIUN`t:
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 Rr
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 sews a disposal system on the above captioned property.
Type of system:
El Other CZ Flo LJ
Subsurface No. of exact length
Drainage Field ditches of each ditch_ feet
Alarm ❑ H2O1-ine ❑
PWR Line
Septic Tank: /CK) 0 gallons Pump Tank: gallons
width of depth of
ditches �✓ feet ditches inches
French Drain Required: Linear feet /
Authorized State Age c``� Date f G(�12G�2
/,Z -,5-- 2,9 V111