OP RHTE# ~ 11194, ~ Harnett County Department of Public Health 2 0 6 8 4
PERMIT # Operation Permit
C New Installation Lam" leptlc Tank ❑ Repair 2"'Nitrification line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) >8 L c,~ rt v t Ll-C SUBDIVISION 4 s-k-i', d LOT # / 3 7
System Installer: Tc d &ry Registration #
Basement with plumbing: ❑ Garage P"lumber of Bedrooms
Type of Water Supply: ❑ Community E4*""Public ❑ Well Distance from well feet
System Type: 77T b 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.
r vo
r ,
h S ~
cti o
fl
..o
rt:nnn cvnunwnx
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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. 9
N-e F-- _,p M a C- A C- C4
V. Other. - caJ IC -71 VC7
a M aa~c cf c e 2t1 e
tia-0
Following are the specifications for the sews dispo ystem o the ve captioned ro
Type of system: ❑ Conventional Other vAno Ia Q ."C tz'.44eptic Tank: Oo o gallons Pump Tank: 103 6 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 9,00 feet ditches -'7 feet ditches 0 inches
French Drain Reauired: tine faar
Authorized State Aeent 2
Date F) ;