OP RHTE# % /•S a-9 k1 R Harnett County Department of Public Health
PERMIT # R_ U Operation Permit 22932
RNew Installation C'Septic Tank 2�_ Nitrification Line ❑ Repair ❑ Expansion
/ PROPERTY LOCATION: Oyz_r� t ! r fj
Name: (owner) 'J,2 1Y.r1cA SUBDIVISION Cro,r -r LOT # If
System Installer: Sa.r..' Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 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 (arolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the improvement rermtt and tonstructson nutnorization.
131', 7 /`i 1-
1,F,re a 1-,f 'j COQ
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:
r
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
for the sews disposalkystem
on the above captioned property.
Type of system: El
Conventional Rr Other
M.,—M.,—/g - -o 15z / &A_) Septic Tank: /OJ_ y
gallons Pump Tank: 160 ® gallons
Subsurface
N° of
exact length width of
depth of
feet ditches inches
Drainage Field
ditches
of each ditch feet ditches
French Drain Required:
'
ea t
Authorized State Agent :!��s Date W
lkr-A-�-7 d-74