OPHTE # Harnett County Department of Public Health
PERMIT # D Operation Permit 22645
New Installation Septic Tank , Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t""O Oltx 5
Name: (owner) SUBDIVISION JOT # 26
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well i 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:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 abov captione property.
Type of system: El Conventional X Other Ci'•C�` — t c-L �1� Septic Tank: 1 c? d 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch_ feet ditches feet ditches inches
French Drain Required: �� ,N ar feet
Authorized State A¢ent _ 9 ��b Date a�
I a 30 G--