OPHTE# t �ffi 7 Harnett County Department of Public Health
PERMIT # Z- Operation Permit 22657
I Z( New Installation [!f Septic Tank ❑'' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Y47 iZ~- sb'? GO
Name: (owner) C 1 ,,� > SUBDIVISION LOT # )__
System Installer: L I't�jkd Registration #
Basement with plumbing: ❑ Garage C"Number of Bedrooms Lf
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well feet
System Type: ZVla t s'6-- �!jp_, G ! Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contalt 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 `nditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑ Alarm
❑ H12OLine ❑ PWR Line
following are the specifications
for the sewage disposal
system on the above captioned property.
Type of system: El
Conventional ;,Other
Z`; %420 1$4
Septic Tank: / gallons Pump Tank: gallons
Subsurface
No. of
exact length
ditch /dpi feet
width of depth of
ditches feet ditches 1 inches
Drainage Field
ditches
of each
--7(14
French Drain Required:
Linear feet
r^
Authorized State Ant �— Date L
13 -5 -30771 (1)
13 -5 -30771 (2)
13 -5 -30771 (3)
13 -5- 30771(4)
13 -5 -30771 (5)
13 -5 -30771 (6)
13 -5 -30771 (7)
13 -5 -30771 (8)
13 -5 -30771 (11) 13 -5 -30771 (12) 13 -5 -30771 (13)
13 -5 -30771 (9)
13 -5 -30771 (10)