OP RHTE #)l 5 "a6%33Q Harnett County Department of Public Health
PERMIT #�11 bat Operation Permit 22797
ill New Installation X Septic Tank X Nitrification Line F-1 Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION LOT # 5`8
System Installer: H ;)go),A Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 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.
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 ❑ Nox
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 *K Other 90 mP`� o SZ Septic Tank: C> gallons Pump Tank: IOC)® gallons
Subsurface No. of exact length width of depth of
Drainage Field ditche 3 of each ditch td� feet ditches 3 feet ditches Y�71 Z i inches
French Drain Required: _ �. feet
Authorized State Agent V�$--Z Date 3 1