OP RHTE# 42 f= .3°JV2f- Harnett County Department of Public Health
PERMIT # a_5'_S_ Y7 Operation Permit 22600
Z' New Installation E7r Septic Tank 'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: bG c,.S" ZJ
Name: (owner) G "c : SUBDIVISION t LOT # YS"
System Installer: 71 A.,; Ai, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _ 7
Type of Water Supply: ❑ Community Of 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.
ims system nas peen mstauea in compuance wnn appucame north Lamina uenerar xatutes, times Tor sewage treatment ana uaposai, ana au conaitions or the improvement rermit ana Lonstrucuon Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
111. 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 ❑
Following are the specifications for the seewwa e disposal system on the above captioned property.
Type of system: El Conventional ltd Other A,--2- Septic Tank: /c-'OU
Subsurface No. of exact length width of
Drainage Field ditches of each ditch ad y feet ditches -7
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches /8 inches
French Drain Required: Linear feet
C %
Authorized State Agent c>,� -.�f Date
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