OPHTE# iL� -5 =3-54�e7 1� Harnett County Department of Public Health 23406
PERMIT # Q ®27-7 Operation Permit
New Installation �R Septic Tank X Nitrification Line El Repair El Expansion
PROPERTY LOCATION: V)
Name: (owner) TI) _ e \Aom L-, LL C, SUBDIVISION LOT # 1119
System Installer: �>,2r�A En, Registration #
Basement with plumbing: ❑ Garage �K Number of Bedrooms Ll
Type of Water Supply: ❑ Community "k Public ❑ Well Distance from well NCO feet
System Type: 7ZZ= 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.
rLnr11 t, NUMVirx
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 disposals stem on the above captionekroperty.
Type of system: ❑ Conventional A Other »�eRC .2_ i � ;1 Septic Tank: VMQ) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditties_„ E of each ditch 1 l} feet ditches feet ditches 1 'Z°30 inches
French Drain Required: `�'°' feet
Authorized State Agent ti --, Date lG
11-4