OPHTE# J °i 'A I Harnett County Department of Public Health
PERMIT # �Q_3 � s Operation Permit 22808
I New Installation '�K Septic Tank X Nitrikation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Lvc,_ IZD
Name: (owner) 1 C. ova SUBDIVISION S w te-i"V tom; O LOT # C.B
System Installer: H Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community 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:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation a
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional Other -- �1 Otis Septic Tank: TQO 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field d tcc eess'� of each ditch feet ditches 3 feet ditches ° � � inches
French Drain ReQuired: �C� r
Authorized State Agent Date