OP RHTE# oAc~ati'7 o2 Harnett County Department of Public Health 212 6 6
PERMIT # ass~~ Operation Permit
New Installation 'N Septic Tank ❑ Repair ~K' Nitrification Line ❑ Expansion
PROPERTY LOCATION: Hwy 'Q ~SoNa
Name: (owner) ~.•j C~ ~5-cvvc'~ a SUBDIVISION -T, ~L,,, PotiN LOT # 3<.
System Installer: 23 A-T-e.A Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well l~ feet
System Type: 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.
ims 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.
Car
F
( in 4 R
tt Pte'
J
f'ERMiT CONDfTIOKS:
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 ❑ NoA
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: ❑ Conventional Other ?y rt* 'f n C~C,n66SzL gJ,wt~ Septic Tank: 1006 gallons Pump Tank: 1000
Subsurface No. of gallons
exact length width of depth of
Drainage Field ditches of each ditch aas feet ditches 3 feet ditches 1
French Drain Required: inches
I;- root
Authorized State Agent DC-,\s Date 0A
~'~~~0
70
6
i4
g t
P
Ir
mom
I
xa.
f ~
fs 1
;
"~vMll'~~r
F
t
t
k'
a n
; j
T
ham. .a.~Nh
t ! -
.
PR
~
' L