OPHTE# ' 5 31"00 -I Harnett County Department of Public Health
PERMIT # a -1345 Operation Permit 22851
New Installation - Septic Tank Nitrification Line ❑ Repair ❑ Expansion
t PROPERTY LOCATION:
Name: (owner) �.v t.,`c.P. ` Ac. 0Q)LC_ SUBDIVISION LOT #
System Installer: M 6YQ a- S-s % Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well MO 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 compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal ystem on the above captioned property.
Type of system: ❑ Conventional ' Other NA R - h -7 Septic Tank: 1 � d gallons Pump Tank: gallons
Subsurface\ �No. of exact length width of depth of
Drainage Field dRc� of each ditch Z0 feet ditches feet ditches inches
French Drain Required: near feet
Authorized State Agent y`������, Date — --I I -)�
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal ystem on the above captioned property.
Type of system: ❑ Conventional ' Other NA R - h -7 Septic Tank: 1 � d gallons Pump Tank: gallons
Subsurface\ �No. of exact length width of depth of
Drainage Field dRc� of each ditch Z0 feet ditches feet ditches inches
French Drain Required: near feet
Authorized State Agent y`������, Date — --I I -)�
13-5- -51e)09