OPHTE# /I 5-x.7 `12-L Harnett County Department of Public Health
PERMIT # =Zt~~3f3 Operation Permit 22029
New Installation ICI Septic Tank R~' Nitrification Line ❑ Repair ❑ Expansion
pp PROPERTY LOCATION: C 14 q)-1
Name: (owner) koA,C, v- .f-G,v T,44-i;r,~,, SUBDIVISION C--/f' Zztty LOT # l
System Installer: M Registration #
Basement with plumbing: ❑ Garage El Number of Bedrooms
Type of Water Supply: ❑ Community IZPublic ❑ Well Distance from well feet
System Type: 1M G 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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PFRMIT flINDITION( G
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional 91 Other 6-Z- Septic Tank: /cd gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches o2 of each ditch ~o~ UU feet ditches 3 feet ditches l inches
French Drain Required: Linear feet
Authorized State Agent ~ -Cif Date `~~a 8 /2-'//
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