OPHTE # Harnett County Department of Public Health
PERMIT # 9L__)O6S Operation Permit 22534
New Installation 1K Septic Tank ')�r Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M Lam, - Q_,
Name: (owner) SUBDIVISION S-6 mgo LOT #
System Installer: d Eo > x-4—riw Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms >'
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tdU feet
System Type:%i. 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
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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditcTtes�_
French Drain Reauired:
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the abovl!e��c,apti ed property.
XOther tia,L tvi Septic Tank: f ®o® gallons Pump Tank: gallons
exact length width of depth of
of each ditch 1 9 ® feet ditches feet ditches 3 inches
�.� `bieear feet
Authorized State Agent Date t
I -,),- 5- a� N)