OPHTE# 1" 5 -C-r,-7 Harnett County Department of Public Health
PERMIT # Operation Permit 22640
New Installation 'X Se tic Tank X Nitrification Line F1 Repair ❑ Expansion
PROPERTY LOCATION: ass
Name: (owner) %q,j=!Z n C--n-) SUBDIVISION C,.tahw�-. -, ; LOT # �-
System Installer: Mv W4 --A2 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community _ Public ❑ Well Distance from well 10 ® 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
with applicable North Carolina General Statutes, Rules for Sewage Ireatment and Disposal, and all conditions m the Improvement rermit and lonstruction Autnonzation.
0
PERMIT 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 ❑ N01K
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E2 V, ow Septic Tank: l060
Subsurface — -N4 of n exact length width of
Drainage Field ditch of each ditch 130 feet ditches
French Drain Reauired: �\ \_ \ r feet
Authorized State Agent N\ \ \NV \ A5 Date
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches N inches
13- 5 -36U-7