OPHTEO_, = Harnett County Department of Public Health
PERMIT # 3'�i® Operation Permit 22642
New Installation _.. Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �NSit�,�G� Sc�cz
Name: (owner) G2E> z J =, d Co „� 7 . SUBDIVISION LOT # Ak
System Installer: � V1 P�QLr--5 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.
rtnrtrt LUNUrtwNS:
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
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 abovf captionq property.
Type of system: ❑ Conventional Other C- 'NAB i. Septic Tank: 10 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drai"ge fie}d — ches of each ditch feet ditches feet ditches inches
French Drain ReQ_R t
Authorized State Agent JAS Date 1411-1