OPHTE# \ 6 Harnett County Department of Public Health
PERMIT # �`�tiba Operation Permit 22776
New Installation "R Septic Tank '5� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Pte,
Name: (owner) i_-o� e, SUBDIVISION LOT # _
System Installer: o P,V r t Registration #
Basement with plumbing: ❑ Garage `@l Number of Bedrooms Li
Type of Water Supply: ❑ Community '15�' Public ❑ Well Distance from well t. 0 Q feet
System Type: a 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 rystem nas peen instauea in compuance wim appucame norm Larouna uenerai natutes, nines for Sewage treatment and omsposai, and au conditions m the
s QD
FtKMII LUNUIIIUN):
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
F11
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Permit and Lonstructlon Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional Other °� Septic Tank: 1 ®8 e gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 S® feet ditches feet ditches inches
French Drain Required: '` —4w_ea t
Authorized State Agent— �����``��'V�� `r �S Date ` ) 1