OPHTE# I �, _ � �—� �6q Harnett County Department of Public Health
PERMIT # Operation Permit 22909
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ii �cao-row c
Name: (owner) SUBDIVISION LOT # 1_
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 O feet
System Type: i e 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:
❑ 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 Other E�_Z- 'V-"Ow Septic Tank: 10Q) 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field dilthe 1 of each ditch 0 i 0 feet ditches 3 feet ditches inches
French Drain Required: Line t
Authorized State A¢ent �``���� 5 Date