OPHTE #; `5'- Z' 1-4, 1 Harnett County Department of Public Health
PERMIT # Z i L i Operation Permit 22496
❑" New Installation 2' Septic Tank ❑� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:: — i&,,z:r ® Ztob5 e y �Z-�
Name: (owner) -c, ,, SUBDIVISION LOT #_
System Installer:' 4 rt Registration #
Basement with plumbing: ❑ Garage El Number of Bedrooms
Type of Water Supply: ❑ CommunityA F-,l Public ❑ Well Distance from well 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 nas been installed In complla .
wan applicable North Larolma beneml )tatutes, 8ules for )ewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
PtKMII LUNDIIIUNJ:
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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch _ feet
French Drain Required: Linear feet
Authorized State
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: I Z 0 gallons Pump Tank: gallons
width of depth of
ditches feet ditches ZCa inches
Date 's -- k-1 - 1
12 -5 -29761 (2) 12 -5 -29761 (3) 12 -5 -29761 (4) 12 -5 -29761 (5) 12 -5 -29761 (6)
12 -5 -29761 (7) 12 -5 -29761 (8) 12 -5 -29761 (1)
12 -5 -29761 (1) 12 -5 -29761 (2) 12 -5 -29761 (3) 12 -5 -29761 (4) 12 -5 -29761 (5)
12 -5 -29761 (6) 12 -5 -29761 (7) 12 -5 -29761 (8)