OPHTE# \3- 53,:�)"53 Harnett County Department of Public Health
PERMIT # `�-''s Operation Permit 22904
New Installation N Septic Tank )� Nitrifi 'on Line ❑ Repair ❑ Expansion
\\ PROPERTY LOCATION: VpNo )fatty
Name: (owner) SUBDIVISION 7 s) LOT # �1 �-
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community ✓ Public ❑ Well Distance from well 1(!�O feet
System Type: = o, 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 onstanea in compuance win appucame norm Lamina uenerai xatutes, ewes for sewage treatment and utsposai, and an conditions of the Improvement Permit and lonstruction Authorization.
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1'LRh111 LUNI) IIM:
I. 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 ❑ N
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 abov captioned property.
Type of system: ❑ Conventional X Other C-NA t Septic Tank: IOC gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field 'ait2hes -��a of each ditch S 5 0 feet ditches 3 feet ditches_ inches
French Drain Reouiredk r
Authorized State hent Date 9 P C 913