OPHTE# 1 ���- ® Harnett County Department of Public Health
PERMIT # �� L'� Operation Permit 22636
New Installation T_J� Septic Tank ,'L'l Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Hwj 2,—1
Name: (owner) SUBDIVISION _FN6Eti Po) v —> LOT # 5
System Installer7— L. v YN Registration #
Basement with plumbing: ❑ Garage)< Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 0 C3 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.
mis system nas oeen msianea in compuance wren appucame norm Laronna aenerai xatutes, ewes for Newage treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
rtKFIII LUIVUIIIUM:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
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 capered property.
Type of system: El Conventional � Other Pv,C N � G Ems- rx--OW Septic Tank: 1d0_ gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of 3 depth of
Drainage Field �ltches - ,. of each ditch a-1 b feet ditches feet ditches i�i inches
French Drain Required:. \1 `'� -inear feet
Authorized State Agent Date
I Q � 5 - �.5'��,d