OPHTE# 6D�— 5- ��- -t--)3 Harnett County Department of Public Health
PERMIT #���3 Operation Permit 22792
New Installation ,1�k Septic Tank Nitrification line ❑ Repair F-1 Expansion
PROPERTY LOCATION: \A I(L&.
Name: (owner) SUBDIVISION K, oz -jA,o LOT # Li-;t,
System Installer: 'H e&Q)�A C. Registration # T
Basement with plumbing: ❑ Garage "R Number of Bedrooms 1+
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 400 feet
System Type: ll } }�� �a 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
rtnrllI LUNUIIlUNY
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 ❑ Na
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
following are the specifications for the sewage disposal system on t�l above captioned property.
Type of system: ❑ Conventional X Other P yrne \ o E Z T—LQ1y
Subsurface No. of exact length
Drainage Field ditc es of each ditch , g feet
French Drain Reauired: r ��S
Alarm ❑ 1-12O1-ine ❑ PWR Line
Septic Tank: CbOa gallons Pump Tank: 10 ®® gallons
width of depth of
ditches 3 feet ditches 30 Q. inches
Authorized State Agent u,,W Date