OP RH T E # 1 5- r GV- Harnett County Department of Public Health 23156
PERMIT # 0 eration Permit
New Installation A Septic Tank Nitrification Line F-1 Repair F-1 Expansion
PROPERTY LOCATION: O®G®D
Name: (owner) i-{ -)—I C -;o�5a, -S-c3 (2.S SUBDIVISION d LOT
System Installer: e )s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well i ®® feet
System Type: c , 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 compbance wan applicable aottn Carolina benerai statutes, awes for sewage treatment ana uisposai, ana au conamons of the improvement rermit ana construction nutnonzation.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
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2
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2
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional opera ion conditions, maintenance and reporting.
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: gallons
Subsurface !iotche. of exact length width of depth of
Drainage field of each ditch ® feet ditches ^'✓` feet ditches inches
French Drain Required mar feet
Authorized State Agents Date �'�
I -�- S-30( yw-