OPHTE# `� �� Harnett County Department of Public Health 23132
PERMIT # �'7Gnl °t Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �c.s
Name: (owner) NA'Init C N;ncLUC,`5 t o SUBDIVISION \ 2;,ii 2s R ,fl C�- LOT # r 6
System Installer: WA ec25 c "!-s it v mgt,A C- Registration #
Basement with plumbing: ❑ Garage �< Number of Bedrooms j
Type of Water Supply: ❑ Comm uni Public ❑ Well Distance from well ! ® 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 mstahea in compliance with applicable north larohna beneral )tatutes, Rules tar )ewaAe Ireatment and
rtKIIII LUNUII UNY
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
and all conditions of the Improvement Permit and Construction Authorization.
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 ct
maintenance and reporting.
❑ 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 PU mP—'V Ct C Z- --F-tow Septic Tank: Lop 0 gallons Pump Tank: 1006 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch '�7 0 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ��..� — /�� -'44 zl f __ Date / /Z 7 / z (:" y