OPHTE# 1-3 '� Harnett County Department of Public Health
PERMIT # Operation Permit 22897
New Installation XI Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: V60 N0 vL- 1.. -t,s
Name: (owner) Lc, SUBDIVISION LOT #
System Installer: C., Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ` ❑ Public X Well Distance from well 100 feet
System Type: Q-. 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:
II. 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 ❑ No'X
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 "y Other E.-Z- Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of {�
Drainage Field ditches .> of each ditch '?,Q feet ditches_ feet ditches ��� °BC inches
French Drain Required: ine et
Authorized State Agent 3 Date 3 13