OP RHTE# o -7- sij 1 ~o ear L Harnett County Department of Public Health 19911
PERMIT # `I a Operation Permit
J~[ New Installation '-J~2 Septic Tank ❑ Repaieg Nitrification Line ❑ Expansion
_ n PROPERTY LOCATION:
Name: (owner) ,
r c ~ v
C _ SUBDIVISION C 0 LOT # 2 3
System Installer. ~l~I c~SIIOt ~n Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 777-
Type of Water Su ply: ❑ Community Public ❑ Well Distance from well S J feet
System Type: ,(`u~vr ~ J y jTT f~ Types Y and YI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
TMs system has been msWW in c"Oance with appki" North (arofna General Statutes. Rules to Sewage Treatment and Disposal and 211 w(d6 m of the Msprmemem Permit and Comuumon Authorization
LC C C'L.-, q `/l.
Qtc l~
a
Orgy,,,
NY's `i r `O 3~
sL
S L _ J
f~
PFANIT rr)Nn1TInNt
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Y. Other
following are the specifications for the sewage disposal ,;ystem on the al~ove captioned property.
Type of system: ❑ Conventional Z Other ll'_ \.A ~ . ~ Size of tank: Septic Tank: 1210 3 gallons Pump Tank: -L) J _ gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 4 a feet ditches - feet ditches 13 Q\1 inches
French Drain Required: linear feet
Authorized State Agent - Date
r~,~