OPHTE# '�)- 3�3�i� Harnett County Department of Public Health
PERMIT #i �i Operation Permit 22834
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: zc�C QS7
Name: (owner) UL q') I uev SUBDIVISION LOT # a
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 5
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: r' 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.
finis system nas oeen mstanea in compuance wim appucame norm Lamina Uenerai statutes, naves mr sewage treatment ana uisposai, ana an conamons or the improvement rerma ana Lonstrucnon Authorization.
CL)_-1 or $f,» L E 20
I' MII CUNUIIIUN):
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:
® °
(3X `�k s 1 • l u '�> G CC CD
❑
D -Box
❑ Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for
the sewage disposal system on the abovF property.
Type of system:
❑ Conventional
,caption
Other C,�A f�s�C� W1� `
Septic Tank: 1 Q ®® gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
di ches of each ditch 1 6 n feet
ditches 3 feet ditches 3 ®� inches
French Drain Reauired —,_
Linear
Authorized State hent 1\ » ��`�`� \\ �-�J_ Date
V5-S--5)3--)LA