OPHTE# ra ° Harnett County Department of Public Health
PERMIT #
Operation Permit
22794
New Installation L� Septic Tank Nitrification Line
F-1 Repair ❑ Expansion
PROPERTY LOCATION: mil) o c
Name: (owner) S P�v v --j
� A o
SUBDIVISION �N��N `tea r�3
LOT # 41�
System Installer:
Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community
Public ❑
Well Distance from well 40Q) feet
System Type:
b
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
rCnrll l t.uIM I MU:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NoX
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 K Other P v,'r19 7 c, �t 011 Septic Tank: M CX? gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field di hes of each ditch g G feet ditches feet ditches ,$' J inches
French Drain Reouired: ; �
Authorized State Agent ���� ___ y�� \� PC- 73S Date