OPHTE# 121 a�a� -}' Harnett County Department of Public Health
PERMIT # `� 01 Operation Permit 22444
New Installation �N Septic Tank > ` Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M
Name: (owner) SUBDIVISION LOT # -3 Li_
System Installer: __'71V0 1R>w---s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public El Well Distance from well 1 DC) 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.
ma system nas peen mstauea in compuance wan appooabie north larolma General xatutes, Nules for )ewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
rtKMIl LUNUIIIUNN:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
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 sewage disposal system on the above captiongd property.
Type of system: ❑ Conventional Other C,),icN Y)QC-ca_ Septic Tank: 1C(�D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field -ditc4u of each ditch 30 0 feet ditches feet ditches '�LUli inches
French Drain Required: y
Authorized State Agent_�NA Date
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