OP RHTE# ;J-s W�,e Harnett County Department of Public Health
PERMIT # Z 7 S 5-? Operation Permit 22971
12` New Installation Y Septic Tank f'Nitriffcation Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:] e—rz,,'�
Name: (owner) / SUBDIVISION i.JA-Ar, tea' LOT # 5,
System Installer: Registration #
Basement with plumbing: ❑ Garage ff Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: i Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must 94tact 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,fand all conditions of the Improvement Permit and Construction Authorization
rtKMI l IUNUI I TUNS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew5e disposal system on the above captioned property.
Type of system: ❑ Conventional 16 Other 25ft i Septic Tank: gallons Pump Tank: gallons
Subsurface No. of .f exact length width of depth of
Drainage Field ditches I of each ditch tD feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Age t Date 'T' L3'— F3
13- 5- 30589R (1) 13- 5- 30589R (2) 13- 5- 30589R (3) 13- 5- 30589R (4) 13- 5- 30589R (5)
13- 5- 30589R (6) 13- 5- 30589R (7) Dougs MHP Repair 003