OP RHTE# ! - Harnett County Department of Public Health
PERMIT # ZZZ�Z Operation Permit 22665
Z' New Installation Septic Tank e Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �,ulta 5� i ,moo' r6
Name: (owner) c —5 SUBDIVISION LOT #
System Installer: ' ox Registration #
Basement with plumbing: El Gar e El u er of Bedrooms 3
Type of Water Supply: ❑ Community LJ' Public ❑ Well Distance from well feet
System Type: 2 "�Z `fir' G— Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contac Health Department 6 months nd +^_expiration for permit renewal.
This system has been installed in compliance with applicable North CarollIna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the 11provement Permit and Construction Authorization
PERMIT CONDITIONS:
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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the s disposal system on the above captioned property.
Type of system: 11 entional ewa Conv Other VC—Q&) - -Ac FZC: r Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches Zy inches
French Drain Required: Linear feet
Authorized State Age F )�, Date _ t ► `�