OP RHTE#iS —5 02 Harnett County Department of Public Health23777
PERMIT #u Operation P�CYIIt
New Installation IJ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: "71q t
Name: (owner) SUBDIVISION LOT #
System Installer: ' Registration #
Basement with plumbing: ❑ Garagetuber of Be oms .3
Type of Water Supply: ElCommunity ;01Public Er Well Distance from well 16n' feet
System Type: �� �� t�i"Z r7 _,5� t� Tr. �.�1� es V and VI Systems expire in 5 years.
(In accordance with Table V a) Own�mustntactFfealth Department 6 month prior to expiration for permit renewal.
This system has been installed in compliance with applicable North [arolin4 General Statutes, Rules for Sewage Treatment and Disposal, and all condi4ns of the
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
Ill. 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.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewn a disposal system on the above captioned property.
Type of system: ❑ Conventional Other 6%/M 3 Septic Tank: /OD U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ! 0 a feet ditches .S feet ditches inches
French Drain Reauired: Linear feet
Authorized State A t R—� (iA,�--� Date o "
15-5-36239 (1)
15-5-36239 (2)
15-5-36239 (3)
15-5-36239 (4)
15-5-36239 (5)
15-5-36239 (6)
15-5-36239 (7)
15-5-36239 (11) 15-5-36239 (12)
15-5-36239 (8)
15-5-36239 (9)
15-5-36239 (10)