OPHTE# 13- 5- 3®_T5e`-► Harnett County Department of Public Health
PERMIT # ` Operation Permit 22846
New Installation N Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) �aP xa,12+5 "gz-N S SUBDIVISION LOT # 1�
System Installer: " 1 � � Registration #
Basement with plumbing: ❑ Garage 4 Number of Bedrooms
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well 10 Q 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.
Ins system has been Installed In compliance wan applicable north Larolma 0eneral xatutes, nines for )ewage Treatment and uisposal, and all Conditions or the
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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
rermit and Lonstruchon Authorization.
V. Other:
S -)S56"
\ zdD4 P, ap PAt' ED Q`,'
SI-r;. V�-,
9m"C'CL 7'. ,sv Sat LLn.Si A i rj__
c_"t:',- rm
91OLSeD ON srcf- W<dL'4- QF'vGa.,ot.sC�NP,1— iP
S=uW
❑
D -Box ❑
Pump ❑
Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the above
j done roperty.
Type of system:
El Conventional
Other CMS' Cam'
��
Septic Tank: ► 0 0 Q gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches l
of each ditch
feet
ditches 3 feet ditches �L °2-9 inches
French Drain Required: timar feet RLL02w O'j
Authorized State Agent Date , �'