OPHTE #'--�-536GI Harnett County Department of Public Health
PERMIT # '11`'2'6 Operation Permit 22900
New Installation Septic TankXl Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: G;
Name: (owner) SUBDIVISION VNc) tee. LOT # �-
System Installer: e--, Sers Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: El Communi 'K Public El Well Distance from well I �® feet
System Type: 1 04 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 ❑
H2O1-ine ❑
PWR Line
Following are the specifications for the sewage disposals( stem on the above captioned p erty.
Type of system: ❑ Conventional Other t!- psm?.Ea— �► Septic Tank: gallons Pump Tank: gallons
Subsurface N on_ f exact length width of depth of
Drainage Field ditches of each ditch i�C� feet ditches feet ditches r�� �� inches
French Drain Reouired: a
Authorized State Agent ��, � Date 9
?�-- � -3> � �,