OPHTE#{ Harnett County Department of Public Health
PERMIT # Operation Permit 22251
2 New Installation E?"SSeptic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
°t
Name: (owner) l•~t SUBDIVISIONr LOT
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 34A,,A
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet c~,-y
2 ` ~~es V and VI Systems expire bn 5 years.
System Type: ~
(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.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned property 3 1=4
Type of system: ❑ Conventional Other Z5""/z, ;Z",7) C r r~ - Septic ank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch 80 feet ditches - feet ditches inches
French Drain Required: Linear feet
Authorized State Date
d 7
11-5-27861 (2)
11-5-27861 (4)
s
s
1
11-5-28040 (1)
11-5-28040 (2)
11-5-28040 (3)
11-5-28040 (4) 11-5-28040 (5)
14.
n
11-5-28040 (6)
11-5-28040 (7)
11-5-28040 (8)
11-5-28040 (9) 11-5-28040 (10)
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E
t
+-c
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11-5-28040(11)
11-5-28040(12)
11-5-28040(13)