OPFITE# U q -S- a),-? Harnett County Department of Public Health 2 0 7 0 6
PERMIT # 3 Operation Permit
New Installation 2~Septlc Tank ❑ Repair 2-(Nitrification Line ❑ Expansion
4^ 'l PROPERTY LOCATION: 2?~er4
Name: (owner) Q. C ~n ttvA.e S~ SUBDIVISION ~ e.• ct;",f t LOT # 7~
System Installer. !`e. t', r, nn XEy> -'c Registration #
Basement with plumbing: ❑ Garage 53'11umber of Bedrooms 3
Type of Water Supply: ❑ Community 2"-public ❑ Well Distance from well feet
System Type: JTZ G- 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.
[his 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
I `'lti e Q~~2 t
l
3`
r J¢c.K I LJ I A
I
PERMIT CONDITIONS: {j /y\ A f
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Y. Other. N tLV` ~tC dj<
Following are the specifications for the sewsYsposal system on the above captioned property.
Type of system: El Conventional I_? Other ~ Z /c X, c.J Septic Tank: & v gallons Pump Tank gallons
Subsurface No. Of exact length width of depth of
Drainage Field ditches- of each ditch feet ditches 2 feet ditches d~ inches
French Drain Required:
linear feet
Authorized State Agent
w
Date 41-2,(1 a Cl
;t
r
r 1
~ a~ fr
~ ~ ~l
"
p
aimm
d
.
„y,r
A■i
aF
,A 1~ H
t
t'
ar ~
~
49
it,
T