OPHTE# - Harnett County Department of Public Health
PERMIT # Operation Permit 22867
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) &L~i- SUBDIVISION 9,� M, ,-s (i ®, 7T LOT # QL `
System Installer: ..moo N i Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms '�
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: —) i 1 21D 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
rtnrlll t.UNUIIIUNY
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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Fallowing are the specifications for the sewage dispossystem on he abo captioned propeY
Type of system: ❑ Conventional Other y Me a NA NvNIa£cL Septic Tank: f o a Q
Subsurface —Ne exact length width of
Drainage Field ditches ' of each ditch G O feet ditches 3
French Drain Reauire&%-._� —Li
Authorized State Agent, �1&6 Date 'Y
H2OLine ❑ PWR Line
gallons Pump Tank: 1000 gallons
depth of
feet ditches ``� "a inches
1w � t1, E X\ION* �