OPHTE #1`c k-5- -a��,�0 Harnett County Department of Public Health
PERMIT # f:i l Operation Permit 22778
New Installation V Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:Oc,cs Q
Name: (owner) SUBDIVISION LOT # 3a,
System Installer: G���t�� Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 5
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t ® 0 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.
II. 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:
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So ,L V W QucON G 1 A VSL C.,'3&J�c
❑
D -Box
❑ Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications for
Type of system: ❑ Conventional
the sewage disposal system on the abo a tapf red property.
X Other
Septic Tank: VXS—'4 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches—
of each ditch feet
ditches feet ditches 2K5 inches
French Drain Required:
feet
Authorized State Agent ���� ��� `� _ Date