OPHTE# �� SJy.� Harnett County Department of Public Health
PERMIT # 3 Operation Permit 22621
New Installation 8� Septic Tank % Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) c &Z.. \t®M SUBDIVISION LOT # \�`7
System Installer: Registration #
Basement with plumbing: ❑ Garage ''Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tQ)0 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.
INS system nas Been Instaneo In compliance wlm appucame Norm laronna ueneral )tatutes, fiules for )ewake Ireatment and Ulsposal, and all conditions of the
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rtKMII LUNUIIIUN):
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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Permit and Lonstruction Authorization.
❑ 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 Other —, Septic Tank: tC)O® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ches of each ditch 8o feet ditches feet ditches inches
French Drain Reauired: feet
Authorized State Agent � � '\N`\ N::> Date