OPHTE# �t—1 J 1 Harnett County Department of Public Health 23318
PERMIT # �`77b Operation Permit
✓,n New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ).&
Name: (owner) i � -tj QN 1Ap'R, SUBDIVISION "" LOT #
System Installer: 10 n 4a C�_�go:y Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 5'Z'�- 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 _. - 1
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 dispos ystem on the above captioned operty.
Type of system: ❑ Conventional Other ', 0) � Septic Tank: ! gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage fieM e— ,� ditches of each ditch C� feet ditches feet ditches " inches
French Drain Required: _\ Linear feet
Authorized State pent \ _~'_ \ 5 Date