OPHTE# J --s ;~'l Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 7 2 3
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: MA2~.5~
Name: (owner) ~,oc3 1>~o~s~soc~C S SUBDIVISIONscFncc~ LOT # `]3
System Installer: 1 o CiC~w tJ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms j
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1-<3 0 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.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'K Other CM Tv4NQ, Septic Tank: 1®(310 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field &Wites
, of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent O\\ \~``1~\ RkY~5 Date
PERMIT CONDITIONS:
1. 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 ❑ NOA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
{
wo
1
r
' j
fir
4
i