OPHTE# '3 -51-1 '13 Harnett County Department of Public Health
PERMIT # Operation Permit 22859
I New 'Installation 'X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M PQ Z
Name: (owner) gEsz• ��c�M�� ��`"'�f5 SUBDIVISION Ly�,6: ZQD LOT #
System Installer: '6- zLo f rA Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well V(50 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 rermit and lonstruction Authorization.
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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 system on the above Captioned operty.
,\AN Q 6a. �� Septic Tank: 1�4t'}
Type of system: El Conventional X Other l
gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of exact length width of
Z���eet of each ditch 4 feet ditches
depth of
feet ditches 3� inches
French Drain Required:
Authorized State Agent \� `11111 X15 Date
� 3- �3Q'l �