OP RHTE#—C)-)-5,1 �,SQIMZ Harnett County Department of Public Health 23536
PERMIT #peration Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I �MlaGaa.ir-tF CJa
Name: (owner) 0NOME5 SUBDIVISION T'Hc Bugs; LOT # I
System Installer: ,s erT r,ie-.xt- %,,A c) Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 2 Public ❑ Well Distance from well two 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 compliance with applicable North larolma beneral Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
'fish ,u(- 02.
rtKMI I IUND11IUNN:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional A Other E -L FL -0w Septic Tank: 1000 gallons Pump Tank:
Subsurface of exact length width of depth of
Drainage Field ditches of each ditch 160 feet ditches feet ditches X-.14
French Drain Require Linear feet
Authorized State Agent\"- �V 1 , Date Va.fW/ `t 1"'
PWR Line
gallons
inches
Q-)_5-_ %CSad (�