OP RRHTE# 11-5 °'2,(;A') CLQ_ Harnett County Department of Public Health
PERMIT # 2)�53 Operation Permit 22541
New Installation K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: OvgxL,, i � g
Name: (owner) 09-- 1—k� , SUBDIVISION S-5 LOT # tb3
System Installer: Registration #
Basement with plumbing: ❑ Garage )9, Number of Bedrooms .)
Type of Water Supply: ❑ Community ', Public ❑ Well Distance from well 100 feet
System Type: c Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Ij 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.
II. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ,`� Other E.°Z. FL w Septic Tank: 1(000) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditrheS of each ditch 15 O feet ditches feet ditches inches
French Drain Required: b§qLfeet
Authorized State Avent ��� �y��� Q(_-� Date
11 -5 C�,)ac�,q