OPH T E # - Cc'� Harnett County Department of Public Health
PERMIT Operation Permit 22831
New lnstallation%R Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: A2.x5
Name: (owner) f- 05ULt. -f�,%A_Q 0m66 SUBDIVISION �X-S '-- LOT # S5
System Installer: `Ti.o 924-44rJ Registration #
Basement with plumbing: ❑ Garage 'K Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 b Ci 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.
Ihis 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
rtKMII LUNUMUNY
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: EsF-C—_ su9vl-4is10,4 T") >R '�— "-I— f-i;�4lkC;-' D-SF, ME.;J—) t-c3 ) 0-j
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal �s,Ystem on the above captioned prope
Type of system: ❑ Conventional Other yIN P7_0 Gi kp'g "D Septic Tank: X000 gallons Pump Tank: t ti00 gallons
Subsurface No. of exact length width of depth of
Drainage Field - ditches of each ditch feet ditches 3 feet ditches inches
French Drain Require `- -``�_` ttear`�il feet
Authorized State Agent \ '� K 3 Date b
13—s— 3oiC 3