OPHTE# ✓Z- s= �Zsz.2q Harnett County Department of Public Health
PERMIT # d, Operation Permit 22388
2� New Installation C�Septic Tank 2'- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: T
Name: (owner) J 1 c- A c, K', 14 ,-r SUBDIVISION LOT # /t%d
System Installer: By. a � �r Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -3
Type of Water Supply: ❑ Community Z' Public ❑ Well Distance from well feet
System Type: Z—L 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.
ims system nas ueen ms[anea in compnance wim appucame norm larona uenerai xatutes, naves for )ewage treatment and uisposal, and an conditions of the Improvement Permit and Construction Authorization.
C6 nAQQ -r C +,
r ,l
aQ�
-r
1 �
rtnMu wnuntunx
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 seewway disposal system on the above captioned property.
Type of system: El Conventional Lf Other EZ le4 Septic Tank: ��c) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 131_0 feet ditches feet ditches inches
French Drain Required: Linear feet /
Authorized State Agent �C Date �Zo / zg/ 2-