OPHTE# Harnett County Department of •
PERMIT #.'4q Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 0 ocs
Name: (owner) y rY,q rya �5 2 ��, �, SUBDIVISION �, �. Z' ®6� LOT # G i
System Installer: i r- vcv a wc' n, Registration #
Basement with plumbing: ❑ Garage IN Number of Bedrooms
Type of Water Supply: ❑ Community ]K Public ❑ Well Distance from well ® feet
System Type: _ 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.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NoM
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 <w t7 ❑2 r�o Septic Tank: t e2 ®C7 gallons Pump Tank: f 000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ) of each ditch 8 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent�.� �iA' . lee—&f Date C // (- /` ri /('/
J3 s- 3a�3 y