OPHTE# CA® Jam'' 9� 5.17 Harnett County Department of Public Health
PERMIT # Operation Permit 22609
9 -'New Installation eptic Tank 14-°1Vitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION LOT #
System Installer: •c, Registration # ^--M
Basement with plumbing: ❑ Garage Lumber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well CG>Z) feet
System Type: - f4 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.
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PHM11 LUNDIIIUNS:
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 12—
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
E+-11 D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the bo cap .oned property.
Type of system: ❑ Conventional Other .5Z 4' , J:7/P Septic Tank: 1 ) gallons Pump Tank: f ' 6 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches -7 feet ditches r "—' inches
French Drain Required: Linear feet
Authorized State Agent a5�� �'� Date