OPHTE# `�® 5_ZM53 Harnett County Department of Public Health
PERMIT # ��3 Operation Permit 22822
New Installation A Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) -Y r4 Q vc;rs> ° SUBDIVISION ;N ^LOT # —7 0
System Installer: 11-,.ct; ,:�q ,15 Qt. )0"; Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well iC",) Q feet
System Type: = r, 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.
11. 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 ❑
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional X Other 'Z- V LQ) W
Subsurface No. of exact length
Drainage field ��Cifztles— of each ditch Q- ®0 feet
French Drain Reauired: \ _ `L•iaear feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: 100 gallons Pump Tank: gallons
width of depth of
ditches feet ditches ) inches
Authorized State Avent _� � ,����. r Date —(-'