OPHTE# /,3 -s,3da Ir Harnett County Department of Public Health
PERMIT # a i3z2- Operation Permit 22957
Its New Installation [FX—Septic Tank 2"Nitriffcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ✓�. its .ea
Name: (owner) a tt -f SUBDIVISION LOT #
System Installer: / �, l Q�� f p >L: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms /ate pY
Type of Water Supply: ❑ Community [;KPublic ❑ Well Distanci from well feet
System Type: Tl1 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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PERhltl 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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional Other V -, L k `/ U., �e-
Subsurface No. of exact length
Drainage Field ditches of each ditch S-U feet
French Drain Required: Linear feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: / °Ci gallons Pump Tank: gallons
width of 3 depth of
ditches ` feet ditches 3 (*' 4 inches
Authorized State Agent/ j,., .��®:. - ,Ier,6- Date Ic, // (. 12-C" 7
/3 -5 - ,708 Ir