OPERATIONS PERMITHTE# 1a. -s= a 9 (oq Harnett County Department of Public Health
PERMIT # cZ.7? J 3 z Operation Permit 22377
O Installation Septic Tank 2" Line ❑ Repair ❑ Expansion
PROPERTY LOCATION. -- M e or,s. c`C /ed.
Name: (owner) I c Q e 1 / . c ,&Le, - 1 , SUBDIVISION C LOT # 1`— 2
System Installer: 0-r^1 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms rZ
Type of Water Supply: ❑ Community lAblic ❑ Well Distance from well feet
System Type: -rr7' �� 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 oeen mstanea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
fS`t
1 �
Q
4, c
t �1
and all conditions of the
I -1) 1
R
t�1
D[DA11T rnsimm�u�
a�
Y \
c C G� A-' c i;C
Permit and Construction Authorization.
I. Performance:
11. 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 2
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2O1 ❑ PWR Line
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system:
❑ Conventional 9 Other ...
C4;,
Septic Tank: o v a gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches y
of each ditch a c1 d feet
ditches 17 feet ditches _ f inches
French Drain Required: Linear feet
c
Authorized State Agen w Date 9 /R? ( 20 <2-
~�� -V