OPHTE# iz -'�) - 4d) Harnett County Department of Public Health
PERMIT # Z Operation Permit 22492
New Installation O`d Septic Tank Q"' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: iY4 . n
Name: (owner) Sig ' i % I` l) SUBDIVISION i k_� i LOT # 92-
System Installer: `' g,( ' Registration #
Basement with plumbing: ❑ Garage d dumber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 4s � ` ' 1 <, - Types V and VI Systems expire in 5 years.
(In accordance with able V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
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.
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 I Other
Septic Tank: / 0 G' 0
gallons Pump Tank: 1 n` 0 gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches 3
of each ditch S0 feet ditches
feet ' ditches Z f: 6 inches
French Drain Required: Linear feet
Al
g
Authorized State A t'° �
' Date