OP RHTE# It'_c.;._2.Dia',5Q, Harnett County Department of Public Health
PERMIT # Operation Permit 22919
New Installation )g Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: LOR,
Name: (owner) cati;sa aY m L- 1,,—i N,,As 0 SUBDIVISION F 'Agm LOT # °`-
System Installer: DC- c C. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3 a
Type of Water Supply: ❑ Communi ❑ Public X Well Distance from well -�� feet
System Type: 2 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:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other: {� y a P 1;�%t,pN 42—_X� >;_ o E CNCC;( -GQ
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property..
Type of system: El Conventional X Other Pu �� &)k O$ (Qs14rL)P) Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface __Na_ exact length width of depth of
Drainage Field ditches of each ditch � b (y feet ditches -3 feet ditches inches
French Drain Renuired:
Authorized State Agent ��� \� `> Date D la�