OP RHTE# 'I �6-r Harnett County Department of Public Health
PERMIT # 27oZ Operation Permit 22498
2" New Installation 2" Septic Tank E2 Nitrification Line ❑ Repair El Expansion
_ ? PROPERTY LOCATION: J.S32- 1-,4-,j4 -y..r�b
Name: (owner) -� " ' ° ' SUBDIVISION M- LOT # 7—
System Installer: Is Registration #
Basement with plumbing: ❑ Garage 2FNumber of Bedrooms
Type of Water Supply: ❑ Community Rr Public ❑ Well Distance from well feet
System Type: Z50/ i2�'i)u ,,,gf =t� c %�`�K''' °r 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 compliance with applicable North CarolinaAeneral Statutes, Rules for Sewage Treatment and Dispq, and all conditions of the I1hprivement Perrat and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance wt Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑ (cf�,?r'
If yes, see attached sheet for additional operation conditions, maintenance and reporting. 3
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1.ine ❑ PWR Line
Following are the specifications for the sewaje disposal s stem on the above captioned property.
Type of system: El Conventional Other 211%b %is' :54 ;iy— M-"—Septic Tank: �t a 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 7— of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agen c'LL' _rs Date 3
12- 5- 28552RR (36)