OPHTE# 1b-� Harnett County Department of Public Health
PERMIT # a_7 Ll 1) Operation Permit 22885
New Installation Septic TankNitrification Line ❑ Repair ❑ Expansion
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Name: (owner) '7S t'4�ANV—'(
System Installer: >- -n,NG.w5
Basement with plumbing: ❑ Garage '!k Number of Be
Type of Water Supply: ❑ Community X Public ❑
System Type:
(In accordance with Table V a)
PROPERTY LOCATION:
�. �1,�N%SUBDIVISION LOT #
Registration #
Brooms
Well Distance from well � (30 feet
Types V and VI Systems expire in 5 years.
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.
111. 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 property.
Type of system: ❑ Conventional Other .2 t_ GV Septic Tank: f4(3 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch of each ditch i Cr6 feet ditches feet ditches _ inches
French Drain Required:_ � et
Authorized State Agent �.��, `�� \'���� ec_)A� Date
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