OP RHTE #I 5� -5C53IC9— Harnett County Department of Public Health
PERMIT # a51�4 OlDeration Permit 22807
New Installation IR Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: '0)_(Z4 QL>
Name: (owner) SPa v -4 SUBDIVISION kE, �,� F�xi s�.5 LOT # S3
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community '4�k Public ❑ Well Distance from well 1 00 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.
Ims 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
rtKMII CUNUMUNY
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
WJl,.—, _g"
5--� G. �t -j r.D
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the
ew ge disposals stem on the above captioned property.
2-- 'V t 0 O
Type of system: ❑
Conventional
Other to w Septic Tank: O
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
dltc 1
of each ditch feet ditches
feet ditches 1`t, inches
French Drain Required:
o aY4et
Authorized State Agent X 'v XSINZ � Date