OP RHTE# E" - 5 � Harnett County Department of Public Health
PERMIT #� Operation Permit 22899
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C`l
Name: (owner) Z-j , SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well 1 CXD 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:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other `F- Z- Septic Tank: 0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field is s--- , of each ditch feet ditches -3 feet ditches inches
French Drain Required:_ � �feet
Authorized State Agent -S Date
� 3- �5_�S� I �-,