OPHTE# l :3–J -.3/j-kq Harnett County Department of Public Health
PERMIT # s�zZ- Operation Permit 22948
52"New Installation Septic Tank O- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �
Name: (owner) �i t ie 11a1, eJ 44 C SUBDIVISION Qck^.�, -A- JOT # oL�l
System Installer: ".I ;C_ G-G - ter Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well feet
System Type: 24: b 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
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DEDMIT rnuntTinuu
I. 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwsaKdispos system on the above captione property.
Type of system: ❑ Conventional o other F0�+ �� ( U = property.
41' Septic Tank: a5 0 gallons Pump Tank: oa IJ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches f of each ditch d 'A) feet ditches 3 feet ditches XV– A inches
French Drain Required: Linear feet
Authorized State Agent � \ \yy s 9ti_ '� Date t�
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