OP RHTE #62`t9 _z 113j Z Harnett County Department of Public Health
PERMIT # 7--72-1 t� Operation Permit . � 22486
NeW Installation Y Septic Tank ®° Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,5r' vt e- +'
Name: (owner) 9 1 _ SUBDIVISION LOT # s
System Installer: p� i� " s�� Registration #
Basement with plumbing: ❑ Garage L� ,dumber of Bedrooms 3
Type of Water Supply: El Community CZ �° Public ❑ Well Distance from well feet
System Type: 99 0 pes V and VI Systems expire in 5 years.
(In accordance with Table V a) Own s 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 ❑ H2OLine ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional IJ Other Zj_% ila` t a Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 101,' feet ditches feet ditches Z 4 J / inches
French Drain Required: Linear feet
Authorized State A t __ ____ /2--- Date
12- 5- 29939R (1)
12- 5- 29939R (2)
12- 5- 29939R (3)
12- 5- 29939R (4)
12- 5- 29939R (5)
12- 5- 29939R (6)
12- 5- 29939R (7)
12- 5- 29939R (8)
12- 5- 29939R (9)
12- 5- 29939R (10)