OPHTE# i pan U Harnett County Department of Public Health
PERMIT # �� s- Operation Permit 22881
New Installation Septic Tank �< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATIO : 1 i ra (_EQ.► V-0
Name: (owner) N\—\O SnS-5 SUBDIVISION LOT # 5°1
System Installer: \'4Kq AC..7Z-7Sr '0 '.4L -5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 14 d 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
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation a
itions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captiffk(d property.
Type of system: E4,Conventional Other VA24 l / Septic Tank: fCnC74 gallons Pump Tank: gallons
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch E50 feet ditches feet ditches "a inches
French Drain Reouired: _ at'`iuet
Authorized State Agent Date
V3- - S °3 7a') ,