OP RRHTE# 1�- t� ®�Z, Harnett County Department of Public Health
PERMIT # �� 1 Operation Permit 22641
New Installation )R, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 0 C/S
Name: (owner) '�i—� `, 2vc;:�1 o N SUBDIVISION LOT # '33
System Installer: C)-sy 15 S—ScL -, .rcL ,--0 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 1+
Type of Water Supply: ❑ Communi _1� Public ❑ Well Distance from well 1 C) 0 feet
System Type: tMif t�, 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 larotma General )tatutes, Xules for )ewage Ireatment and
la
PERMIT CONDITIONS:
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 c(
IV. Operation:
V. Other:
Plbu .S 6
sposal, and all conditions of the
t
maintenance and reporting.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conv ' I Xxi Other E 7- Septic Tank: f 00 ® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch if each ditch Q feet ditches feet ditches inches
French Drain Reauired: Lied
Authorized State Agent X�" ����� �_ P44y Date - T )-I-
Q.- 5. 301 ',Nm