OPHTE# l °° Harnett County Department of Public Health
PERMIT # 9:7 L)CD-) Operation Permit 22841
New Installation "K, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) vCSL �Apm SUBDIVISION LOT # i 0
System Installer: }-5 G Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 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
rtKMII LUNI IILINY
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 ❑ Nt
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
—00-P ON
" i'wam 0P_&
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
for
the sewage disposal system on the above captioned property.
Type of system: El
Conventional
Other P6rAi V'teo\,I Septic Tank: (bC ®
d -
gallons Pump Tank: 1000 gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch La C)(3 feet ditches �3
feet ditches inches
French Drain Required:
��
� r feet
Authorized State Agent �a� �� �' Date I
13- S- 35:62.