OP RNTE# A J--,3J-d- x192 Harnett County Department of Public Health 23444
PERMIT # a 8 i 3 �/ Operation PermitZrNew Installation Rr' Septic Tank Nitrification Line ❑ Repair ❑ Expansion
/ PROPERTY LOCATION: P Ra.
Name: (owner) 2�.�c�� N �. 111 SUBDIVISION LOT #
System Installer: �� c�cr f 'pr/.` L Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public 2"'Well Distance from well /M feet
System Type: Z 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.
❑us system nas ueen mscaueu in compuance wan appucame norm carouna ueneral statutes, rules Ior )ewage Ireatment and Ulsposal, and all conditions of the
i
1
rtKMII cununiuns:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 2'_
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the seeww� e�lsposal ystem on thQ ab a captioned property.
Type of system: ElConventional Lf Others F ��= `��--6� Septic Tank:
Subsurface No. of exact length1 width of
,
Drainage Field ditches of each ditch 7' 0() feet ditches _
French Drain Required: Linear feet
Permit and Construction Authorization.
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches ()—/8 inches
Authorized State AgeDate '-7 l °2f
/5S f )S"2 V a h