OPHTE #j D 5 - :4SQ� Harnett County Department of Public Health
PERMIT # - n Operation Permit 22771
New Installation "K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: IY 1
Name: (owner) SUBDIVISION JOT #
System Installer: o �bOAw N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well boa feet
System Type: o 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:
1. 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 ❑ Nox
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 sewage disposal system on the above captio
property.
Type of system:
❑ Conventional Other
C')A�" g 1� �
Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches ,
of each ditch l 0
feet ditches 3 feet ditches inches n r
French Drain Required: r eet -
Authorized State Agent �'5 Date r '