OP RHTE# 13- 5- -'5)"X51Q. Harnett County Department of Public Health 23124
PERMIT # Overation_ Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M Ag_ys
Name: (owner) r��CLe-%cC �+ony_5 �t4 C- SUBDIVISION CsooP%15 �'p+a LOT #
System Installer: �7-_y ®•E CSMLN4XL Registration #
Basement with plumbing: ❑ Garage `.� Number of Bedrooms L1
Type of Water Supply: El Community Public El Well Distance from well 1Od 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.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal �sYstem on the above cc ttione roperty.
Type of system: ❑ Conventional '� Other ` 1A'>%g 'jz42 V �►'` Septic Tank: 160 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches , of each ditch -I feet ditches feet ditches ' inches
French Drain Required: _ 'near feet
Authorized State Agent �`.� `��'��_Qa)5 Date
�+ i Y`