OP RHTE# s� s a���9 Harnett County Department of Public Health
PERMIT # a� �� Operation Permit 22593
C New Installation Septic Tank C�rNitriffcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: U-.): Q L -c,1" ,/U.
Name: (owner) SUBDIVISION Jw LOT #
System Installer: c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms y
Type of Water Supply: ❑ Community Pr Public ❑ Well Distance from well 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.
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
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211111 gill] ;11]FIU]ILK
I. Performance: System shall perform in accordance with Rule .1961.
11. 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: El Conventional 1i Other 4�Z 9'%�— Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 8 feet ditches_ feet ditches aq - X inches
French Drain Required: Linear feet f
Authorized State Agen %� - w ,e�ffi Date 1, '5/ v!3
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