OPHTE# ' 1-51 a~4 61 Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 ! 4
New Installation ~ Septic Tank \K Nitrification Line ❑ Repair ❑ Expansion
t PROPERTY LOCATION: Q(3c, s
Name: (owner) \Aj N t t ~ip r,~62v c~ ~o N SUBDIVISION LOT # tiCO
System Installer: -I ~-c o ~L_v 9~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms r 1
Type of Water Supply: ❑ Community Public ❑ Well Distance from well L(bi7) 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 nas peen mstauea in compuance wan appucame Norm Larohna benerai xatutes, KUM for sewage treatment ana Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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rtKMII LUNUMUNS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ` Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 5 o feet ditches feet ditches inches
French Drain Required: _`s'LinAu feet
Authorized State Agent _N~' rzGt Date G
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