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OP RHTE# d1-5- Harnett County Department of Public Health PERMIT # ~~1 3 t Operation Permit 22202 New Installation Septic Tank )1 Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: V\ G~ "c~;N:Lo 1~z Name: (owner) \;4 j c4 sit Cc 3t1';Q y<!: x o t.! SUBDIVISION 5v mmt cz,~~z ~ LOT # System Installer: 9 "ao-No,i5 P~v,,t,~ , G Registration # Basement with plumbing: ❑ Garage 'K Number of Bedrooms Type of Water Supply: ❑ community 'IR Public ❑ Well Distance from well t®© feet System Type: -_-Z-77 _~g 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. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization PERMIT CONDITIONS: 1. 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 ❑ No If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other: ❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional 't2l~ Other F--Z- » ow Septic Tank: 1 O b O gallons Pump Tank: gallons Subsurface No. of ` exact length width of depth of Drainage Field ditches 1 lo ch ditch N S U feet ditches ~ feet ditches e =a inches french Drain Reauired: - d. ,Lin Authorized State Agent Date v 11, I Y u amp, ? fi F w F ly 7f j .