OP RHTE# 13 " 5%'-?!z -7 Harnett County Department of Public Health
PERMIT # z Operation Per 23019
LJ' New Installati Septic Tank [Y° Nitrification Line ❑ Reaair ❑ Exuansion
PROPERTY LOCATION: f gS_-�
Name: (owner) L�; .zf„ C SUBDIVISION LOT # J
System Installer: L,t,acxrt� '� Registration #
Basement with plumbing: ❑ Garage t B Number of Bedrooms
Type of Water Supply: ❑ Community + Df� Public ❑ Well Distance from well feet
System Type: i rZ -b t < fir i 6 4�- -Z Types V and VI Systems expire in 5 year
(In accordance with Table V a) t Owner must conta t Health Department 6 months prior to ex iration 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 Improjement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961. , 4 r�
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' disposal system on the above captioned property.
Type of system: ❑ Conventional C` Other I2P4;Zi�M(4 Septic Tank: 1 c gallons Pump Tank: gallons
Subsurface No. of t exact length width of depth of c
Drainage field ditches �_ of each ditch 1 tat; feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Xgent -' /� 0 ' Date 1 2— l (, q
13- 5- 31727R (1)
13- 5- 31727R (2)
13- 5- 31727R (3)
13- 5- 31727R (4)
13- 5- 31727R (5)
13- 5- 31727R (6)
13- 5- 31727R (11)
13- 5- 31727R (7)
13- 5- 31727R (8)
13- 5- 31727R (9)
13- 5- 31727R (10)