OPHTE# t f . - 3txrs-3 Harnett County Department of Public Health
PERMIT # 7-7 3 Operation Permit 22666
ZNew Installation 1�' Septic Tank [Z Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5� s z, s- mr)
Name: (owner) 15(-L Iiv, SUBDIVISION QLM-zi &i{�rZ LOT # 12
System Installer: Ttysd"j Registration #
Basement with plumbing: ❑ Garage C�3` umber of Bedrooms J
Type of Water Supply: ❑ Community I!f Public ❑ Well Distance from well feet
System Type: , &7- (,Lw4 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must Antact Health Department 6 months prior to expiration Ifo r permit renewal.
This system has been installed in
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement ffermit and Construction Authorization.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 7' Other 25''ii2j,5bO -Uf0 _5.6 Septic Tank: jc<_-� b— gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches '30 T$ inches
French Drain Required: Linear feet _
Authorized State ent Date `�
1 14.
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