OP-CAN'T SIGN OFF IN HTE - per Donna Johnson permits not purchasedHTE# ,a 1� Harnett County Department of Public Health
PERMIT # Operation Permit 22889
New Installation '1 Sept c Tank Nitrification Line ❑ Repair ❑ Expansion
r PROPERTY LOCATION:
Name: (owner) 1 ti � eo-i,) Q-V't ' qe°r�'%) S Q Al r;-fi SUBDIVISION LOT #
System Installer: L G Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community l�<\ Public ❑ Well Distance from well Ede 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.
ims system has been installed in compliance with applicable north larolina t,eneral Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
rtmvi tufrunfunr
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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches of each ditch 1 feet ditches 3
French Drain Required:
Authorized State Agent Q—F--,39 Date "K
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches �-�� inches
t1
13, 5,1-3 i--� �11