OPHTE# 13-- JiS�t Harnett County Department of Public Health
PERMIT # ���►� Operation Permit 22902
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: a`i \4 -
Name: (owner) a %,, SUBDIVISION - Ra t LOT # `S-b
System Installer: 5 ' tVez-N �-� Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 d 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 Permit and Construction Authorization
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ l!0A
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the sp
Type of system: ❑
Subsurface
Drainage Field
French Drain Reauii1
Authorized State Age
_ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
cations for the ewage disposal system on the above captioned property.
Dnv n i Other Z- 4l Septic Tank: t(Z�CJ 0 gallons Pump Tank: gallons
No. of exact length width of depth of ,
ditches ch ditch `c�� feet ditches feet ditches ��" ° inches
Date " l Ill
�3- 5 -3) 5,�G