OP R'ITE # \ Li —5- -�� ) 0 Q, Harnett County Department of Public Health 2 3 3 111
PERMIT 0 eration Permit
New Installation Septic Tank Nitrification Line El Repair F-1 Expansion
PROPERTY LOCATION: �S e L--
Name: (owner) 1 ts2,n '�Non,ES SUBDIVISION LOT # Ci
System Installer: '��--v, Registration #
Basement with plumbing: ❑ Garage` Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: a 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:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H120Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ca tione roperty.
Type of system: ❑ Conventional Other l a1 Dim Llr Septic Tank: T DO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditcie I of each ditch feet ditches feet ditches I'R' inches
French Drain Reauire . �`�_ _ �et
Authorized State Agent e.G",S Date `1 L0
`ti- 5-®� l i 6v4,,,