OPHTE# 4a.��a ®a3� Harnett County Department of Public Health
PERMIT # �� } e1g Operation Permit 22780
New Installation N Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C-K
Name: (owner) 0 SUBDIVISION �ftdS�t`& �'-��F _ LOT #
System Installer: Vtii0CC, N� 5 4t_vrnQ.? \0C� Registration #
Basement with plumbing: ❑ Garage 1< Number of Bedrooms
Type of Water Supply: ❑ Community K Public ❑ Well Distance from well 1 Z) 0 feet
System Type: ==-!!;N 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.
Ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation a
IV. Operation:
maintenance and reporting.
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional 'M Other
Subsurface No. of exact length
Drainaue Field ditches of each ditch 0 feet
Alarm ❑ 1-12O1-ine ❑
PWR Line
Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches feet ditches i inches
French Drain Required: ear feet
Date
Authorized State Agent 'ti5 L _