OPHTE# Q 5-30 Harnett County Department of Public Health
PERMIT # Operation Permit 22798
New Installation X Septic Tank �< Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Ooc,
Name: (owner) WYAr4 Cr qv Gran► 1Nc, SUBDIVISION % 9,,,®G6 LOT # 1_
System Installer: 1 ;o,.,s Lyrns),-t c. Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 10® feet
System Type: =1--19 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
1
Pas�a
1
► -iov�E to
f tBNll LUNUI I IUNS:
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 El No%N
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 'E Z F' --o`W Septic Tank: 1 000
gallons Pump Tank: gallons
Subsurface
of
exact length width of
depth of
Drainage Field
ditches
of each ditch a-0 feet ditches .3
feet ditches ) �� inches
French Drain Reauired:
r�C�.�
feet
Authorized State Agent N�— 11 '` _ Date a
I'l- S --Y��-�L-