OP RHTE# ►o-s-~3-Irz. Harnett County Department of Public Health 21 4 9 6
PERMIT #~a- Operation Permit
New Installation X Septic Tank ❑ Repair'X Nitrification Line ❑ Expansion
PROPERTY LOCATION: )A,,4y')Q"vJ
Name: (owner) Nvr e c- \komer,,, m\ SUBDIVISION = x,-.~c;,E,, Qoi mE LOT # g~1
System Installer: R. c. IN 0 LLRegistration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community )Q Public ❑ Well Distance from well 1ST O feet t
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.
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PERMIT CONDITIONS:
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 ❑ NoV
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 p{operty.
Type of system: ❑ Conventional Other Ct+a~i c 36 H 10
Septic Tank: l 00 gallons Pump tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditc of each ditch feet ditches 3 feet ditches inches
french Drain Reouired:
Authorized State Agent `(4G y Date 6 IG I 10