OPH T E # k Q -Sa f:13'-)i Harnett County Department of Public Health
PERMIT # DJ~23~1 Operation Permit 2 2 2 3 8
New Installation 'K Septic Tank X Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: 0
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Name: (owner) 'r-l yr►rr Co.-~s1c cL,,3C,N (5>J SUBDIVISION '~i,a6~,.T Qa~N LOT #
System Installer-7-1_vAoa'Nd o_> Qc..utn9\rA Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community . Public ❑ Well Distance from well ! Od 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS:
1. 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 operafon conditions, maintenance and reporting.
❑
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
following are the specifications for the ewage disposal system on the above captioned property.
Type of system:
❑ Conventional Other
'PUrn ) o E2_ V'_0,' Septic Tank: '0 ®O
gallons Pump Tank: S 6'a0 gallons
Subsurface
No. of
exact length width of
1 S
3
depth of
Sa
Drainage Field
ditches
feet ditches -
of each ditch
feet ditches
` inches
French Drain Required. Line t
Authorized State Agent Date
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