OPHTE# 13— Harnett County Department of Public Health
PERMIT Sl Operation Permit 22837
)�Q` New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t'PQc.s
Name: (owner) �4ort P,.QP � -,r,:,CXLS 1 -1--C- SUBDIVISION �,S )A V.5ogj, , LOT #
System Installer: 'Ii�s mow r1 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ,00 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 larolma beneral )tatutes, Hules for )ewage Ireatment and
acs'
and all conditions or the improvement rerml[ and lonstructlon Rumorizatlon.
PERMIT CONDITIONS:
1. 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:
I ai
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Pvmt , CmN A/ Septic Tank: } 000 gallons Pump Tank:l ® ®Cy gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3� feet ditches 3 feet ditches )Q —' } inches
French Drain Reauired: 'ma
Authorized State Agent _������ Date
IR -s 3bCa