OPH T E # is -s a8 6 2- g Harnett County Department of Public Health
PERMIT # 00- 5 -7 9 Operation Permit 22524
Er New Installation C_ Septic Tank 0'—Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: j'6c.kVc j ged-
Name: (owner) SUBDIVISION erf LOT #
System Installer: /�'t�,o(er Y'-'e4' C Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 0'- Public El Well Distance from well feet
_
System Type: � h 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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YtKMII LUNUIIFUNS:
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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewaa disposaaLsystem on the above captione property.
Type of system: El Conventional Conventional Other k- V w a — E- , Ct t.--b Septic Tank: /000 gallons Pump Tank: r 06 0
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 366 feet ditches 3 feet ditches
French Drain Required: ., feet
Authorized State Agent a` , N" 1 5 Date
PWR Line
gallons
inches
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