OPHTE# IZ%S z C-93Z Harnett County Department of Public Health
PERMIT # �/ Operation Permit 22455
G New Installation Septic Tank C7' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION;, - Lh�E � ,C,5
Name: (owner) Z:;jc SUBDIVISION LOT #�
System Installer: -S ,`j��?a,, Registration #
Basement with plumbing: ❑ Garage IX/Number of Bedrooms 3
Type of Water Supply: ❑ Community 1Z Public ❑ Well Distance from well feet
System Type: 1SOtk.L 1—ir -ris; -e'i -2 ,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.
FLnrui Lvnunivnu:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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
V. Other:
❑ D -Box ❑ Pump ❑ Alarm Q H2OLine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 51 Other / C-I)v i-W 4Mt Septic Tank: gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch --ia — feet ditches feet ditches li -51
French Drain Required: Linear feet
Authorized State Ag t Date ° -z q_r 1,
PWR Line
gallons
inches
12 -5 -28832 (1)
12 -5 -28832 (2)
12 -5 -28832 (3)
12 -5 -28832 (4)
12 -5 -28832 (5)
12 -5 -28832 (6)
12 -5 -28832 (7)
12 -5 -28832 (8)
12 -5 -28832 (9)
12 -5 -28832 (10)