OPHTE# 13 -5- '3Qo1 Harnett County Department of Public Health
PERMIT # a-29):] Operation Permit 22815
New Installation k Septic Tank ,Y Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: &y 10Q-F--5-5 C aI yQX V,
Name: (owner) SUBDIVISION C_YeSL&5-1 Po" .J�E LOT # �•`�
System Installer: PMYA f,vr 5 Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community 'T�k Public ❑ Well Distance from well 1 feet
System Type: d tZ 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.
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 th sewage disposals stem on the above captioned property.
Type of system: El Conventional Other Pv 0-P > a- � Septic Tank: 1 o ®G gallons Pump Tank: 140 d gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc 1 of each ditch �u ® feet ditches feet ditches inches
French Drain Required: IN., Line
Authorized State pent �\ Date 6 131 )