OPHTE# �:��.� Harnett County Department of Public Health
PERMIT # D) 6e� Operation Permit 22784
`l New Installation )K� Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 46
Name: (owner) Cy mQE<0_e, ao - SUBDIVISION N, LOT #
System Installer: t ti o R> ao °" aoa Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms —�
Type of Water Supply: ❑ Community Public ❑ Well Distance from well l0 Q feet
System Type: -b 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 ❑ N
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 s stem on the above captioned prope ,
�
Type of system: El Conventional Other u (.,-, 40 C 'P vf'S:C3'EQ_ Septic Tank: 1000 gallons Pump Tank: 'MRD gallons
Subsurface No. of exact length width of depth of
Drainage Field\ ditches of each ditch feet ditches 3 feet ditches S "D-14 inches
French Drain Required: LiKar feet
Authorized State Agent ����� ��� �5 Date 1 a`'