OP RHTE# t' 5- Harnett County Department of Public Health
PERMIT #�5 Operation Permit 22821
' New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ®c,-
Name: (owner) cc, 0%�5 SUBDIVISION 0-�. ci95 LOT #
System Installer: 5 5ia',6GcL-flv-9 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms ._ 5
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 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.
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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
S -i5st^,
So .. Qj21 c k4 A s-. ' so n'-, >a Qy e e C E GR "D\.w G
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal
stem on above captioned �Property .
Type of system:
❑ Conventional Other Ir
\j r, 4 N a -P3 °vvl
Septic Tank: ta? d gallons Pump Tank: N _0 gallons
Subsurface
No. of
exact length
width of depth of
feet ditches �1 "�t inches
Drainage Field
du es of each ditch feet
ditches
French Drain Required:
_
Authorized State Agent ���� �~ ~� _`, � Date G 11)
I I: 5- f-