OPHTE#16-5-n I Ta
PERMIT # aDA91'DI
Name: (owner) JG
System Installer: S
Basement with plumbing: ❑
Type of Water Supply: ❑ Co
System Type:
(In accordance with Table V a)
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
Harnett County Department of Public Health 23829
Operation Permit
❑ New Installation X Septic Tank X Nitrification Line ❑ Repair>f Expansion
PROPERTY LOCATION: PT t ncx,a P:iaec iL, L -N
ri*+ES1 SUBDIVISION LOT #
U t NgQ Registration #
Garage XNumber of Bedrooms .5
unity X Public ❑ Well Distance from well t O 0 feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
t ; t Hoosf OR,vE
\a s
L' w L
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:
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sewage disposal system on the above captione roperty.
Type of system:
❑ Conventional X Other
1+Ae�BGtL �Q�` Septic Tank S��
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch 1 t b feet ditches 3
feet ditches 1Q —QL"� inches
French Drain Required: inear feet
Authorized State Agent 1b.2G1dS Date I I'a