OPHTE# i Z-s-a989q Harnett County Department of Public Health
PERMIT # ai 16 9 Operation Permit 22566
C'New Installation Er Septic Tank K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: % .`n yeti Al
Name: (owner) 4"'c' (Bv' Nc� r SUBDIVISION , 5������ X;44y LOT #
System Installer: 5-0 1- Registration #
Basement with plumbing: ❑ Garage ❑ Iflumber of Bedrooms J
Type of Water Supply: ❑ Community 9 Public ❑ Well Distance from well 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.
inls system nas oeen Installed in compliance wim applicaole nortn Laronna Ueneral Itatutes, %roes for sewage Treatment and Ulsposal, and all conditions or the Improvement Permit and Lonstructlon Authorization.
qO
rtKMII t,unuinuns:
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 ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew dispos system on the above captioned property.
Type of system: ❑ Convi Fl,a Septic Tank: /QdQ gallons Pump Tank: /1300 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a of each ditch —% r feet ditches feet ditches ay-,7i inches
French Drain Required: Linear feet
Authorized State Agent , Wes, C/'�r Date 7 % O/ 0 l,