OPHTE# -�L4 Harnett County Department of Public Health
PERMIT # �6 Operation Permit 22805
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: P-M
Name: (owner) y� L_`"" SUBDIVISION CN7o 4Nra Se1�,sosk5 LOT # 5$
System Installer: C)-; i s 6L-, RNfl Registration #
Basement with plumbing: ❑ Garage �, Number of Bedrooms L4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t feet
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System Ty7=):;, 0�7 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
rcnrnt Lunuutunr
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other >4w Septic Tank: i 0
Subsurface No. of exact length width of
Drainage Field ditches , of each ditch S S® feet ditches 3
French Drain Requireif&—"'`^.--, _ linear feet
H2OLine ❑
PWR Line
gallons Pump Tank: i b 0 6 gallons
depth of
feet ditches R'D�4 inches
Authorized State Agent �- 6Lt__)_�5 __ Date H I ZS
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