OP RHTE# a2 "_`5 _;5a33V_ Harnett County Department of Public Health
PERMIT # el 3(K) Operation Pernt 22663
2" New Installation 13" Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION >ggi /'Vices ou6 &b
Name: (owner) NiZW05 C ee sf ?u",f z. SUBDIVISION r±;,Pst� i t LOT # i _
System Installer: Ir--f Registration #
Basement with plumbing: ❑ Garage Z umber of Bedrooms q00
Type of Water Supply: El Community LJ" Public ❑ Well Distance from well feet
System Type: 7 '13st— fVed,Z ':�5 O'� C. v 740 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
NtRMII LUNUIIIUM:
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, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional YO, L ii Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches Z 1 inches
French Drain Required: Linear feet
Authorized State Age _ � 2 Date 5 —10 _ 13
Ala
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12- 5- 30334R (4) 12- 5- 30334R (5)
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