OPHTE# I ` G1`"1 Harnett County Department of Public Health
PERMIT # a����- Operation Permit 22878
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) o 92v> i_Qcu k_l—(, SUBDIVISION LOT # L�'—)
System Installer: C N Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Commun' Public ❑ Well Distance from well Ilbo feet
System Type: 1 l t 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
PtKMll IUNUIIIUNJ:
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 x
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
S-i_e Suiat) "NN
jC),' T"\f'a S' t C P.CsC G � Entt LbC.t�; �Q�t�
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
for the sewage disposal system on the above ca tioned''p roperty.
Type of system: ❑
Conventional Other
CrAt--, Kl�j —Septic Tank: 40O
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches --
of each ditch S feet ditches
feet ditches 18'��1 inches
French Drain Required:
\ \
Line
Authorized State Agent �.�� ���'\ \\ Ql=� Date 7i5)
1--s @5 --3t�f I`t