OPHTE# lv -S-IS Vai Harnett County Department of Public Health
PERMIT # a�-JIV Operation Permit 22956
2f New Installation 52"Septic Tank ET' Nitrification Line ❑ Repair ❑ Expansion
p PROPERTY LOCATION: PA-f
Name: (owner) Lyle SUBDIVISION LOT # 3Z
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J
Type of Water Supply: ❑ Community EP Public ❑ Well Distance from well feet
System Type: 7
1 _G,— Types V and V1 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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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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewW disposal system on the above captioned property.
Type of system: ❑ Conventional IFI Other Septic Tank: a gallons Pump Tank: _
Subsurface No. of exact length width of depth of
Drainage Field ditches N of each ditch feet ditches feet ditches 16
French Drain Required: Linear feet
Authorized State Agent'/ Date L�/�! L`��
PWR Line
gallons
inches
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