OPHTE # -t3, -5�- j86C, Harnett County Department of Public Health
PERMIT # 0 g Operation Permit 22556
9'-New - Installation c Tank FfeKNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 74,, P-A e- 4,r RJ
Name: (owner) SUBDIVISION -Tc h,,rc, LOT # d,
System Installer: Co..,- c�e.ls;r Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms '/
Type of Water Supply: ❑ Community VPublic ❑ Well Distance from well feet
System Type: j4- G— 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.
ma syster nas peen mstaueo in
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wim appicame norm Larmma uenerai statutes, naves for sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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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:
PVJ 12
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A I_
Y
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑
Following are the specifications for the sews gf disposal system o9 the above captioned property.
Type of system: ❑ Conventional Other 2- F ?G,.., Septic Tank: 1 oV Q gallons Pump Tank: _
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 0 feet ditches �_ feet ditches n
French Drain Reouired: Linear feet
Authorized State ARent_/ Date c2 //X? d
PWR Line
_ gallons
inches
/ ,Z— s_2- 7g8c.