OPHTE #13 -5- -.31 Z0+ Harnett County Department of Public Health
PERMIT # z- . , . Operation Permit / 22697
ew Installation C?* Septic Tank a_ itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) � SUBDIVISION LOT # _
System Installer: S Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: El Community Vpublic ❑ Well Distance from well feet
System Type: 15% �t tom- 1 � M 'ga �► 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 system on the above captioned prop g�
Type of system: ❑ Conventional C? Other $° Septic Tank: _� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 106 feet ditches feet ditches 3t2 It inches
French Drain Required: Linear feet
Authorized State Ag Date a "i#
13 -5 -31209 (1)
13 -5 -31209 (2)
13 -5 -31209 (3)
13 -5- 31209 (4)
13 -5 -31209 (5)
q
1,
1 r
13 -5 -31209 (6)
13 -5 -31209 (7)
13 -5 -31209 (8)
13 -5 -31209 (9)
13 -5- 31209(10)