OPHTE# ` Harnett County Department of Public Health
PERMIT # �3� Operation Permit 22812
New Installation \S� Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: rouezog- - Orz
Name: (owner) c'�Q� -� D� ��� SUBDIVISION 774 4 Burn,, i7 LOT # LCD
System Installer: F.s>v) G 6?<,spa Cxz- Registration #
Basement with plumbing: ❑ Garage � Number of Bedrooms
Type of Water Supply: ❑ Community l Public ❑ Well Distance from well 160 feet
System Type: 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
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 ❑ H20Line ❑
Following are the specifications for the sewage disposal system on the abov captioned, property.
Type of system: ❑ Conventional Other i� %ice Septic Tank: 1000 gallons Pump Tank:
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch 9 feet ditches ? feet ditches
French Drain Reauirei � e
Authorized State Agent � ���\� 06 Date I
PWR Line
gallons
inches