OP RHTE # - 21gg3Z Harnett County Department of Public Health
PERMIT # 6 Z q Operation Permit 2 2 6 51
[A New Installation Z Septic Tank E:9 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION6 -X/573 S AILI lr t
Name: (owner) �� /� SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: Garage VF of�Bed�°oms _
Type of Water S�u ply: Community LJ Public E; Well Distance from well �� feet
System Type: �� 1 L/ s —. r7` ypes V and VI Systems expire in 5 years.
(In accordance with fable V a) IFZ U'T-� Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS: v
I. Performance: System shall perform in accordance with Rule .1961.
II. 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, maintena ce and
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 Other +� in �? 1t Septic Tank: % 0 0 gallons Pump Tank: °` gallons
Subsurface No. of Ixact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age r� Date
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12- 5- 29443R (16)
12- 5- 29443R (17)
12- 5- 29443R (18)
12- 5- 29443R (19)
12- 5- 29443R (20)