OP RHTE# ��— S'a°��i��CL Harnett County Department of Public Health
PERMIT # a-� 161 Operation Permit 22540
New Installation N Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: SKInr. \\,L,— Gt�Uczc,�,�b
Name: (owner) Gout- r-Q;j w,cL MgmF-5 SUBDIVISION LOT #
System Installer: L Aci,y S»a2e C Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Co muni X Public ❑ Well Distance from well tZiG feet
System Type: 0. 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 oeen mstaueo in compliance wim appncame norm laronda tienerai )tatute5, naves tar )ewage treatment and Ulsposal, and all conditions of the Improvement Permit and Construction Authorization.
AIL. SL 113Y
PtKM11 LUNUIIIUNN:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NoIK
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other 1---7 —V -c%[ Septic Tank: 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch -7® feet ditches feet ditches inches
French Drain Reauire'��
Authorized State Agent B`� o" _ \\ 5 Date