OPHTE# i a- 5 _:30NS -0 Harnett County Department of Public Health
PERMIT # 6 Operation Permit 22623
New Installation ° Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION: `mot ti '
Name: (owner) SUBDIVISION P�—T'�o LOT # 'g
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community `- Public ❑ Well Distance from well t 00 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:
1. 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 cc
❑ D -Box C
Following are the specifications for th e
Type of system: El Conventional
Subsurface No. of
Drainage Field ditches �..
French Drain Required'_'_._
maintenance and reporting.
Pump ❑ Alarm El
H2OUne El
PWR Line
sewage disposal system on the abo capt d property.
Other �aPCn 3 C� Septic Tank: C C gallons Pump Tank: gallons
exact length width of depth of
of each ditch 1 �lQ feet ditches feet ditches inches
Authorized State Agent � � �� Qk�qs Date i�