OP RHTE #l��5 ----9'1 o5(2. Harnett County Department of Public Health
PERMIT # 'a1 1 b® Operation Permit 22759
New Installation 'W Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: V. CZ)-\O 5ov -c'h
Name: (owner) )`iAacNE -5 SUBDIVISION C, NLit LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms
Type of Water Supply: ❑ Community '`fk Public ❑ Well Distance from well `40 feet
System Type: c 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.
This system has been installed In
With applicable North larohna beberal )tatute5, KUles for )ewage Ireatment and Disposal, and all conditions of the
"0 05t
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional el Other Z—v ow
Subsurface No. of exact length
Drainage Field es of each ditch Spa feet
French Drain Required: `�\ linear feet
Permit and Lonstruction Authorization.
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: I1 0 i gallons Pump Tank: gallons
width of depth of
ditches feet ditches 1*A-- inches
Authorized State Agent Date ia,iiR