OPHTE# 1y-.".33iaHarnett County Department of Public Health 23955
PERMIT # Operation rmit
FT"New Installation Septic Tank O� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 7—;'A«KA
Name: (owner)l�r- —A SUBDIVISION wi {tit >°�:.i LOT # 132
System Installer: J-6 _T_ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community I'Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in S 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:
Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the sew disposal system on the above captioned properly.
Type of system:
❑ Conventional
Other CZ��Q,.� Septic Tank: /000
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch J100 feet ditches 3
feet ditches 16-4V inches
French Drain Required: Linear feet
c _ `/
Authorized State Agen a — 1& Date X74,1 r-
'31N