OPH T E # X3s-J Jr�a Harnett County Department of Public Health
PERMIT # 02"1 Y 3 Operation Permit 22929
R!" New Installation C�rSeptic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) u SUBDIVISION , - LOT # VV
System Installer: L, y f—A -91C Registration #
Basement with plumbing: El Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community CLPublic ❑ 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.
ims system nas oeen mstanea in compuance wnn appucaoie nortn Laronna t,enerai statutes, Wes for sewage treatment ana omsposai, ana au conmtions of the improvement Permit and Lonstruction Authorization.
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21" (• ^ Jr
FUMii LUNU111UNS:
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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches fC :^ of each ditch feet
French Drain Required: Linear feet
Authorized State Aeen/ �� v,�_ _ �k—iw �; -- '///
Alarm ❑
1-12O1-ine ❑
PWR Line
Septic Tank: % OtY r' gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Date Z � i /2 a 17