OP RHTE# (2-7 - S"OJ ~'d (0-13 2 Harnett County Department of Public Health 19 9 n9
PERMIT "A 4 ~ 2 Operation Permit
-f "ew Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: -C
Name: (owner) w n,A Coy- j SUBDIVISION %7 c LOT # Z
System Installer. ( 14~ Registration # Y y
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _73_
Type of Water Supply- ❑ Community V- Public ❑ Well Distance from well s
J feet
System Type: T( ~L-' 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 hat been imtAd in compliance with appirjbte nard C"m General Statutes, Rules for Sew Treatnent ad Mpo* asd all condtiom of the Improvement Permit and Construction Audmution.
S'J
PERMIT CONDITIONS:
1. Performance:
II. Monitoring.
III. Maintenance:
IV. Operation:
V. Other.
S
L.--i
~J.
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,
Following are the specifications for the sewage disposal spim on the above captioned property.
Type of system: ❑ Conventional Other _ _ 1:/ Size of tank: Septic Tank: 'j J gallons Pump Tank:
Subsurface No. of exact length width of depth of gallons
Drainage Field ditches of each ditch - feet ditches
feet ditches- inches
French Drain Required: linear feet
Authorized State
Date __Q I 3 1 '3q