OPHTE# '. ® -5 -3CAa Harnett County Department of Public Health
PERMIT # -143- _7 Operation Permit 22799
1 New Installation iK Septic Tank �< Nitrification Line ❑ Repair D Expansion
PROPERTY LOCATION: l 114 61E_
Name: (owner) ap%tL�, Homes SUBDIVISION Poi,--T LOT # 4Q,
System Installer: ''5ep�ii c.. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _+
Type of Water Supply: ❑ Community Public ❑ Well Distance from well C Q)0 feet
System Type: a 115 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.
rcnrni WNUMvns.
I. Performance:
II. 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 c
maintenance and reporting.
V. Other: X)cti fWIC) 0 NIn'E iz': aystXLL."monl
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abovp captioned property.
Type of system: El Conventional Other C.� t D Me EQ, O'A Septic Tank: 100 V gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches_ 1 of each ditch a00 feet ditches 3 feet ditches Q-4-20 inches
French Drain Reauired:
Authorized State Agent i�� � f Date
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