OPHTE# i�\-M S- -19 -1 -10 Harnett County Department of Public Health
PERMIT # a`� 1$—i Operation Permit 22789
New Installation t�( Septic Tank ' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ps`t t SUBDIVISION ke;�i t,�,� �'Pa t�,s LOT # '�h_
System Installer: 1- 3t4Qo�, } c. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms f--1
Type of Water Supply: ❑ Community "5� Public ❑ Well Distance from well 5 ®cj feet
System Type: h 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.
Ihls system has been installed in compliance with applicable north larolma beneral Itatutes, Rules for )ewage Ireatment and Disposal, and all conditions df the Improvement Permit and t.onstruction Authorization.
(L.
1
5-10 v s C.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ')q Other P u mQ1 o E-7— 'PLOW Septic Tank: 1000 gallons Pump Tank: 10 QQ gallons
Subsurface No. of exact length width of depth of
Drainage Field s i of each ditch 3L 1) 0 feet ditches _ feet ditches inches
French Drain Required: Linear feet
Authorized State Agent zc-_6 Date