OP RHTE# Harnett County Department of Public Health
PERMIT # ~ - Oeration Permit 21 8 3 2
[~T New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO : A
Name: (owner) r 574--t-c"/ um1 o" SUBDIVISION S- t ag ~ ~ LOT # A ~
System Installer: r~=~wLr1 ,6v.`1~i Registration #
Basement with plumbing: ❑ Garage 94 Number of Bedrooms -7
Type of Water Supply: ❑ Community C2/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.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sews disposal s stem on the above captioned property.
Type of system: ❑ Conventional Others-4 Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of f
Drainage Field ditches of each ditch 'rO feet ditches feet j,.^ditches inches
French Drain Required: Linear feet
~~~I i Date V ~j °l~`
Authorized State Ag 411*'_
qT7 G