OPHTE# \a: s a� Harnett County Department of Public Health
PERMIT # ®�� Operation Permit 22767
4l New Installation )� Septic Tank Nitrification Line F-1 Repair F-1 Expansion
PROPERTY LOCATION: t 'tom QZ
Name: (owner) s A,4 _4j SUBDIVISION t,5 LOT # �6
System Installer: H P%gs;z- , See G Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 ®Q feet
System Type: " 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.
111. 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 disposal system on the above captioned property.
Type of system: ❑
Conventional
Other Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
dit
of each ditch `®0 feet ditches
feet ditches ® inches
French Drain Reauired:
..
_ _ `Liattiar feet
Authorized State Agent Nl_�VIIZ4 , 11_' \ _ 15 Date 1
e �. .� . ,. v.—