OPHTE #I �"- Harnett County Department of Public Health
PERMIT Operation Permit 22871
New Installation Ix Septic Tank X Nitrification Line El Repair El Expansion
PROPERTY LOCATION: oc, CS?
Name: (owner) Cx -5;1v SUBDIVISION C)-tw -nn<3 LOT # L
System Installer: (3rso5 S- M1% Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 5
Type of Water Supply: ❑ Community 1K 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.
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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional Other '?— � . ,--*�
Subsurface No. of exact length _
Drainage Field itches of each ditch y feet
French Drain Reauired: _ 'near feet
Alarm ❑ H2OLine ❑
PWR Line
Septic Tank: S 0 gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent -� °� Date
3-� 5- 336 T�