OP RH T E # ��d °5r -• �4a Harnett County Department of Public Health
PERMIT # %'3. Operation Permit 22601
New Installation 'X Septic Tank 'X Nitri6 tion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 9-
Name: (owner) Pac e -�{-C SUBDIVISION ' -,>Y:N Q>Qo ,tw LOT #
System Installer: L..tlsq3ZL—) 5Hjga ?G Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 4
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well t O feet
System Type: r 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
PERMIT CUNDITIUNS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Noy
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Operation:
Other: CZ YSiE C-'k Ec;*6Q
❑
D -Box ❑
Pump ❑
Alarm El H2OLine El PWR Line
Following are the specifications for the sewage disposal on the above captioned property.
1;,so
Type of system:
❑ Conventional K Other
�..s.iistem
GZ- �'a es
Septic Tank: gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 3
of each ditch I 00 feet
ditches -' feet ditches \ "ta . inches
French Drain Required: Linear feet
Authorized State Age -- - Date /Z -- it t — 1 2
�O� -� r.ra )��U
6 a 5� a.°1��}G