OPHTE# 13-5--. �, Harnett County Department of Public Health
PERMIT # z Operation Permit 1 22691
Z New Installation � Septic Tank a Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: /Nra� G��riAQ.1,6
Name: (owner) , SUBDIVISION r LOT # r-)
System Installer: r}rf�ix� Registration #
Basement with plumbing: ❑ Garage � umber of Bedrooms 3
Type of Water Supply: El Community LQ" Public ❑ Well Distance from well feet
System Type: a 200 ..rr WO sign— .7_t,0?L J9" 4 f^ Lj 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.
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 the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other J,�&i' iEC41 5* Septic Tank: l66C� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
f
Authorized State A nt Date
13 -5 -30706 (1)
13 -5 -30706 (2)
13 -5 -30706 (3)
13 -5 -30706 (4)
13 -5 -30706 (5)
13 -5 -30706 (6)
13 -5 -30706 (7)
13 -5 -30706 (11) 13 -5 -30706 (12)
13 -5 -30706 (8)
13 -5 -30706 (9)
13 -5 -30706 (10)