OPHTE# ,4,: - Harnett County Department of Public Health
PERMIT # Z r G Operation Permit 22491
Er New Installation D"Septic Tank E3° itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:.' 11Id_3
Name: (owner) t ` SUBDIVISION LOT # -Fq
System Installer: .t°e Registration #
Basement with plumbing: ❑ Garage EOumber of Bedrooms _.?-
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well feet
System Type: 7` ""' t.Y�bd.t "�-» ` tee. t3 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:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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.
❑ 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 Er Other Via% 41) Septic Tank: 1021')o gallons Pump Tank: # 00 e-t gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ' feet ditches feet ditches Zq inches
French Drain Required: Linear feet
Authorized State Agent Date `