OP RRHTE# t �'S a$C~1�Ci Harnett County Department of Public Health
PERMIT # -i''dy Oteration Permit 22875
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
a PROPERTY LOCATION: IiA ) i✓Lro m G
Name: (owner) J S-S � SUBDIVISION RNA Y(76 -4 LOT #
System Installer: 1 Y--e S , rn9SC3 N Registration #
Basement with plumbing: ❑ Garage Number o s
Type of Water Supply: ❑ Community Well Distance from well feet
System Type: ---IEL� 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/X
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the s ecifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch )35 feet
French Drain Reauired: Ldme feet
Alarm ❑
H2O1-ine ❑
PWR Line
Septic Tank: t (50 U gallons Pump Tank: gallons
width of depth of
ditches feet ditches IV inches
Authorized State Agent Date
1- 1- 5--29M �' .