OPHTE# 8 5=31- Harnett County Department of Public Health
PERMIT Operation Permit 22888
New Installation ❑ Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
0 t PROPERTY LOCATION: '0"7! a
Name: (owner) mw�E- SUBDIVISION LOT # t S
System Installer: hN czy S 1 o g p G Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community K Public ❑ Well Distance from well i P O 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.
ims system has been instaneo in compliance with applicable North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
rtnrlll LuNvIIiurN3:
I. Performance:
11. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
f lv 6�ti 2S�
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 conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional A8.11 Other f Cs-+ � 95 Septic Tank:
Subsurface No. of exact length width of
Drainage Field citc es Beach ditch `I Q) feet ditches
French Drain Reauired: Cam \eai�fe�. \\
Authorized State Agent �����\��� er--r�5 Date a
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
'3.- 5.31 -7�:�