OPHTE# S�;X`"5 30°0, Harnett County Department of Public Health
PERMIT # �� �`��— .Oteration Permit 22543
New Installation X Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PQD-00A
Name: (owner) SUBDIVISION 2,r. LOT # 4,_
System Installer: t5 ,a.,cxti -Fti Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms q—
Type of Water Supply: ❑ Community ....X Public ❑ Well Distance from well Gtr feet
System Type: ti 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, K_uK for Sewage Ireatment and
�AQ40 C.,4 IIZD
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
❑ D -Box ❑
following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Reouired�\
and all Conditions of [tie Improvement rermlt and lonstruction Authorization.
maintenance and reporting.
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
�ewage disposals stem on the above captioned property.
Other Z. Septic Tank: gallons Pump Tank: gallons
exact length width of depth of
of each ditch feet ditches 3 feet ditches �� inches
Linear feet
Authorized State Agent � 'W�' �? Date
-3or) 0