OPHTE# t-:�-5 -�;�"-A'A ) Harnett County Department of Public Health
PERMIT # Operation Permit 22531
N New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Cz
Name: (owner) D SUBDIVISION LOT #
System Installer: '— P2.. S'r" Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community IKPublic ❑ Well Distance from well 100 feet
System Type: c 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 General 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.
11. 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 ❑ PWR Line
Following are the specifications for the sewage disposals stem o the above captioned property.
Type of system: El Conventional Other Et Septic Tank: ®pCfi gallons Pump Tank: gallons
Subsurface . of exact length width of depth of
Drainage Field ditches of each ditch `0U feet ditches feet ditches inches
French Drain Required: ear feet
Authorized State Agent �\ \��\� \1'\ 1� Date 0 J ! 3 I )I