OPHTE# V�- - Harnett County Department of Public Health
PERMIT # Operation Permit 22833
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) en r : ga L5 E,5 SUBDIVISION LOT # 33
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public El Well Distance from well t 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:
11. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other . — F'rA Septic Tank: ,100 0 gallons Pump Tank: - gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches_. of each ditch C> 0 feet ditches feet ditches M inches
French Drain Reauired:_ feet —
Authorized State Agent ��'` �°�� ` Date CA !�'�
19-- 53o -�s-