OPHTE# 12.— G671 Harnett County Department of Public Health
PERMIT # `4 G�'%5 Operation Permit 22522
New Installation, Septic Tank 'K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: '�NQ'G ZD
Name: (owner) S LL. C. SUBDIVISION YR,2 •5 LOT # QLd
System Installer: H N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well lOO feet
System Type: =1_�b 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 Ge5ual, Statutes, Rules for Sewage Treatment 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 ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal s stem the above captioned property.
Type of system: El Conventional Other 92- I opt Septic Tank: 14 d 0 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches -- of each ditch 50 feet ditches 3 feet ditches ao —3-G
French Drain Required: _ _ e t
Authorized State Agent
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PWR Line
gallons
inches