OPHTE# i3-S-'�Oi 33 Harnett County Department of Public Health
PERMIT # 2L°�-� Operation Permit 22830
New Installation I Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NA 'MC-
Name: (owner) S"v °J ofyy .5 SUBDIVISION '< >AL,!t s LOT #
System Installer: P"Lo "\ " Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L—
Type of Water Supply: ❑ Communi Public El Well Distance from well 100 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.
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- SSE SU6O*Wostoff, V)1 R BOG-. t..0C.N1N0N-_.e>
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other V4�0 �Z.�ix-w )1 Tank: Q
Subsurface No. of exact length width of
Drainage Field ditches of each ditch feet ditches
French Drain Required:
Authorized State Agent ��� ��'� Date
H2OLine ❑
PWR Line
gallons Pump Tank: too O gallons
depth of
feet ditches inches
13- S-3ais3