OP RRHTE# '5'30-11300 12Harnett County Department of Public Health 21 17 4
PERMIT # Q,55- 1Operation Permit
2 tjew Installation Septic Tank ❑ Repair 6- Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1 ~
Name: (owner) K r^~C~~ C~i, „,ih~ SUBDIVISION (,k W.S2 ~~z c LOT # 2,3
System Installer: (X, z k ( d Registration #
Basement with plumbing: ❑ Garage K Number of Bedrooms 3
Type of Water Supply: ❑ Community Q Public ❑ Well Distance from well 100 feet
System Type: of, Z .Macs - 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.
PERMIT CONDITIONS:
North tarouna General statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
"t!W ti' liI
i
3D
S~
Permit and Construction Authorization.
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 6
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional ~ Other Z f7t mot.! Septic Tank: CZ D
gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches , of each ditch feet ditches 3 feet ditches I -~Y inches
French Drain Required: Linear feet
[Authorized State Agent Date
ims system nas oeen mstaiea in compuance with appncame
t ZII
C~ )J
r~
i
~ x
d ,
~ a
~t
IOU
to
yr
1 1t
lY '
21
i
4
a
}
h t
4
7S
4+..
Y '
CD
od
O
Cr'
CU
C)
p