OPHTE# t'�- ff>-_�, Harnett County Department of Public Health
PERMIT # Operation Permit 22918
New Installation N Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
t PROPERTY LOCATION: Ora dal
Name: (owner) SUBDIVISION �} -, a� z �, �`s k�� 1_ LOT #
System Installer: »s 'S- i -x Registration #
Basement with plumbing: ❑ GarageX Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I®® feet
System Type: 1 c3. 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.
ims system has peen mstaueo in compuance with
North larolma beneral statutes, Rules for sewage Ireatment and
U 5 Lai
2,:G y°
and all conditions of the Improvement Permit and Construction Authorization.
rtKMII t.UNUIIIUN):
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E7 —'F—ow Septic Tank: 10C� 0
Subsurface No. of exact length width of
Drainage Field d+tchq of each ditch ` )O feet ditches 3
French Drain Required: Linear feet
H2OLine ❑
46"
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches DL inches
Authorized State Agent �� �� ~�� �'+�_ Date `1l �),5I L3
���'�= �-3�`���