OPATE# 13-5 -3N -7 53 Harnett County Department Health 23308
PERMIT # �� OOeratio —n Permit �L
New Installation Imo{ Septic Tank>J Nitrification Line 1:1 Repair ❑Expansion
PROPERTY on
`�`i �.R�S
Name: (owner) yz-,Y-+ Cf c; St�C-S �►� C.. SUBDIVISION (!zcjPGn.,, "�_i.gxNs LOT # _
System Installer: "% G CoR%n,"62. -- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 Q® feet
System Type: )r> 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.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nye(
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposgl.system on the above captioned property._
Type of system: ❑ ntional Other yf� 1 r� �'+s�f?i2, Septic Tank: f gallons Pump Tank: l0dd gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 0 feet ditches feet ditches ,� inches
French Drain Required:
Authorized State Agent ��� �� �� 5 Date �