OPHTE# is -s =aglow Harnett County Department of Public Health
PERMIT # cZ �0 9 q Operation Permit 22399
C' New Installation 2'-Septic Tank E� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: cO k_,,3ej+
Name: (owner) ��5 �= �.~3 ��� e e r' SUBDIVISION TT' ,ige , Ag,, c- LOT # ! 38
System Installer: G S f _ k C( Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Rr"Public ❑ Well Distance from well feet
System Type: ?_ 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 oeen instanea a compoance wan appncame Norm Lamina uenerai statutes, nines for sewage treatment ana uisposae, ana an conanons of the improvement rermit and Lonstrucnon Autnor¢atlon.
J-0.4 � 1%C-
PERMII CUNDIIIUNS:
1. 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 ❑ H2OLine ❑
PWR Line
Following are the specifications for the sewaze disposal system on t e above captioned property.
Type of system: El Conventional Other lr Z 14-- /O 3 Septic Tank: / Go C) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches cz of each ditch feet ditches —3 feet ditches 3(, f"'Okg inches
French Drain Required: Linear feet p
Authorized State Agent l�—c e Date 17 2— °l Z_
/�-_,f 24/o8