OP RNTE# O~ -5'1`1Sgl~Z Harnett County Department of Public Health 21 4 2 4
PERMIT # a56~~ Operation Permit
New Installation ~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LO(ATION: \,1 \LL t-UC^5 9-0
Name: (owner) g t,pEe SUBDIVISION C~L~ r, P\ (7) LOT # N%
System Installer: W A ~v4 c. ZSa IFS Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community ;9\ Public ❑ Well Distance from well 1 O feet
System Type: S1a ~ 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.
Ns 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
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I LI\IIII 1V11VI11V 11 J.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
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 a¢¢ove captioned perty.
Type of system: ❑ Conventional Other C14oc-\ c6 r,.- lQu IL\~- 4 _ Septic Tank: 10<::<5 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ( of each ditch aOO feet ditches 3 feet ditches 1'~?inches
French Drain Reouired: --A- near fPPt
Authorized State Agent L~ ti ~ fk-,06 Date I'l 1a1 10