OPHTE# 1 _ _3f Harnett County Department of Public Health
PERMIT #? Operation Permit 23004
CK New Installation L� Septic Tank ®" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: / S&: b C ,,
Name: (owner) $A 4 SUBDIVISION LOT # t �,-
System Installer: c c, —y Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms V
Type of Water Supply: ❑ Community 2I Public ❑ Well Distance from well feet
System Type: `�' c 5 �-- 7' „5 Aaa- e"> • f 9pes V and VI Systems expire in 5 years.
(In accordance with Table V a) ' Owner must contact ealth Department 6 months prior to expiration for permit rene I.
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 Constructiol Authorization.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
r
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
9
L
.s
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned roperty.
Type of system: ❑ Conventional 9” Other �� '�' �%� 61i S;A Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches L( of each ditch / feet ditches 3 feet ditches 2 ° / inches
French Drain Required: linear feet
Authorized StateiA¢ent Date