OPHTE# -� Harnett County Department of Public Health
PERMIT # 26 Operation Permit 22829
New Installation 14 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 41 i(L(-- ?.�
Name: (owner) SRvIJ-J cnE5 SUBDIVISION '�F3s ,2 LOT # C
System Installer: N A Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms L-)
Type of Water Supply: ❑ Commum Public ❑ Well Distance from well 4 ®C? 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 ❑ 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 t e specifications for the sewage disposeI system on the above captioned property.
Type of system: ventional `� Other U Y n P `� • �.�- ��•G'nt Septic Tank: ° (1 d ® gallons Pump Tank: i b0Q gallons
Subsurface No. o exact length width of depth of
Drainage Field ditches of each ditch 110 feet ditches 3 feet ditches 1$ ^3-o inches
French Drain Required: et
Authorized State Agent \`� \ \�� \\ t Date r" 1
I a- 5 a&l-7 s