OPHTE #i7 - 7 1 5' , Harnett County Department of Public Health
PERMIT # 2 -70 i Operation Permit 22470
New Installation Y Septic Tank Nitrification Line El Repair F-1 Expansion
PROPERTY LOCATION: 1562- Li4y - - -4,j-'j.
Name: (owner) �t.:,�i,Z-° � c.% ,A SUBDIVISION LOT # _
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 4
Type of Water Supply: ❑ Community C�r Public ❑ Well Distance from well '5 feet
System Type: s'% '7 1� %L-j3 C. *Z t es V and Vjen
expire in 5 years.
(In accordance with Table V a) cpH a epar onths prior to expiration for permit renewal.
This system has been installed in compliance with applicable Non Carolina General Statutes, Rules for Seju Treatment and Disposalonditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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.
a It,
❑ D -Box ❑ _ Pump ❑ Alarm ❑ H2O1.ine ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Lf Other 21 °%e F eptic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch if 3::3 feet ditches feet ditches 2+7 ` inches
French Drain Required: Linear feet
Authorized State A¢e� _ .� Date