OPHTE# �� -�� Harnett County Department of Public Health
PERMIT # %Oct Operation Permit 22763
New Installation N Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: \�1aF
Name: (owner) Sg�y -4-'Y SUBDIVISION LOT #
System Installer: t) P,sLQ 1 -c S G c Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L-)
Type of Water Supply: ❑ Corn!2 i Public ❑ Well Distance from well 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.
PERMIT CONDITIONS:
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other F."2 —�: '-0w Septic Tank: \00 0'
Subsurface No. of exact length width of
Drainage Field of each ditch S d feet ditches
French Drain Reauired: feet
112O1-ine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches 31Q °Li Z inches
Authorized State Agent Date 11-7113
I ",- s Q�525`'