OPHTE# / /- S= a (- 2-8�- Harnett County Department of Public Health
PERMIT # atO3�S Operation Permit 22954
(New Installation LJ Septic Tank d Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /% /4.1 ,, Cr rove led.
Name: (owner) cs.�.`, �.1 P. ,� SUBDIVISION LOT #_
System Installer: 60 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 44
Type of Water Supply: ❑ Community El Public ZWell Distance from well feet
System Type: -��(Z_�r•' 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.
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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 sewa disposal system on the a ove captioned property.
Type of system: ❑ Conventional Other � � �;-.• b Septic Tank: oC3U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _� of each ditch 4400 feet ditches feet ditches XZ -/6 inches
French Drain Reauired: Linear feet
Authorized State hen _/" c'Z ,— 1��-/� .'/ aJ7 Date 2LVL,��1'2_ -j1.7
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