OP RHTE# 0 -7-'r 107 -7 iZ Harnett County Department of Public Health
PERMIT Operation Permit 22682
12New Installation Cl' Septic Tank nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: tj`i.`' C f4iqles
Name: (owner) t`3o- SUBDIVISION 14, iii LOT # —
System Installer: Registration #
Basement with plumbing: ❑ Garage E Ner of Bedrooms 5
Type of Water Suppl : El F- Community Public ❑ Well Distance from well feet
System Type: ' a C- 941ftys V and VI Systems expire in 5 years.
(In accordance with Table V a) f 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
rr:n1111 t.unui UNY
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 sewage disposal system on the above
captioned property.
Type of system: El Conventional
Other .lo G A
r,
Septic Tank: J000 gallons Pump Tank: gallons
Subsurface No. of
exact lengt
0
width of depth of
Drainage Field ditches
of each ditch
feet
ditches feet ditches inches
French Drain Reauired:
Linear feet
Authorized State Date 6-° 13
07- 5- 16927R (1)
07- 5- 16927R (2)
07- 5- 16927R (3) 07- 5- 16927R (4)
07- 5- 16927R (6) 07- 5- 16927R (7) 07- 5- 16927R (8)