OPHTE# °°�'� Harnett County Department of Public Health
PERMIT # 12--7 /13 Operation Permit 22390
ENew Installation 2" Septic Tank Er Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO : % : n5 ,, XJc
Name: (owner) J-4-" C, SUBDIVISION o.E —���� i��: �� LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: TLT' 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.
mis system nas oeen instaneo in compoance witn appucaole Norm laroona beneral )tatutes, rules for )ewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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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 ❑
Following are the specifications for the seewwa� disposal system on the above captioned property.
Type of system: ❑ Conventional Lid" Other EZ Ffa.�
Subsurface No. of exact length
Drainage Field ditches / of each ditch feet
Alarm ❑ H12OLine ❑ PWR Line
Septic Tank: / 000 gallons Pump Tank: gallons
width of depth of
ditches feet ditches 3 inches
trench Drain Required: Linear feet
Authorized State Agent cL a 1/ Date /° lu