OPHTE# /� -�' 3�s-v Harnett County Department of Public Health
PERMIT # Operation Permit 22923
ZNew Installation Er Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Loaf %d,
Name: (owner) SUBDIVISION ?�,��,f�f =�s�� LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Ll
Type of Water Supply: ❑ Community 12 Public ❑ Well Distance from well feet
System Type: ZZr_J 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.
ims system nas peen mstanea in
L;,Lcr 4- 1.4-k)' QK
WM12-0`7 8---
wim appncame norm Lamina uenerai 3mutes, nines for sewage treatment ana uaposai, ana an conatnons of me improvement rermit ana tonstrucaon nutnorizanon.
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:
V. Other:
C�'
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposa system the above captioned property.
Type of system: ❑ Conventional Other �v ^�P o CZF� w Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches 3 of each ditch l00 feet ditches _
H2OLine ❑
PWR Line
/(50(3 gallons Pump Tank: /66'3 gallons
depth of
2 feet ditches /6-22— a2— inches
French Drain Required:
Linear feet
Authorized State Agent A".."
L
r� �= .
p
!` ���f
Date 7/ id 2-61
i ,� Q rlo