OPHTE #� �j'3�D () Harnett County Department of Public Health
PERMIT # a�� Operation Permit 22615
New Installation 1� Septic Tank Nitrification Line O Repair ❑ Expansion
PROPERTY LOCATION: M tam s ��
Name: (owner)� "AO SUBDIVISION LOT # i30
System Installer: Tz�p 24 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -
Type of Water Supply: ❑ Community Public ❑ Well Distance from well CO1® feet
System Type: 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.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No `X
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 system on the above captioned
Type of system: El Conventional Other `� 4AP�M?,c 2 Septic Tank: 101Z) ® gallons Pump Tank: gallons
Subsurface of exact length width of depth of
Drainage Field ditches of each ditch �4 0 feet ditches feet ditches —aZ-} inches
French Drain Required: i ne r eC
Authorized State Agent ��� ��\\�� =�� Date a
13, 5-30HO