OP RHTE#-12 -5 X07 Harnett County Department of Public Health
PERMIT Operation Permit 22467
L�" New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: (� 4 2%
Name: (owner) SUBDIVISION &ZT LOT #
System Installer: C'4 i Registration #
Basement with plumbing: ❑ Garage her of Bedrooms q
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: o 2._. iV7 o— RZd1es V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department months prior to expiration for permit renewal.
This system has been installed in
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V Other-
with applicable North Carolina General Statutes, Rules for Sewage Treatment
0
/
conditions of the Imorovement Permit and Construction Authorization.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional M Other
Subsurface No. of exact length
Drainage Field ditches 2- of each ditch feet
French Drain Reauired: Linear feet
Alarm ❑
1-12O1-ine ❑
PWR Line
Septic Tank: 12100 gallons Pump Tank: gallons
width of depth of p
ditches feet ditches inches
Authorized State AQ�Z Date 10 1
12- 5- 28802R (1)
12- 5- 28802R (2)
12- 5- 28802R (3)
12- 5- 28802R (4)
12- 5- 28802R (5)
12- 5- 28802R (6)
12- 5- 28802R (7)
12- 5- 28802R (8)
12- 5- 28802R (9)
12- 5- 28802R (11)
12- 5- 28802R (12)
12- 5- 28802R (13)
12- 5- 28802R (14)
12- 5- 28802R (10)