OP RHTE# 10-5-may tlyQ Harnett County Department of Public Health 21 5 0 3
PERMIT # X03 Operation Permit
'Eq New Installation N Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LO(ATION: NC2a-
Name: (owner) ~~~t C3os~. C ~.r~R2~ELL SUBDIVISION U--aGP,z- tr,, LOT # _
System Installer: 1-- y SNAa. k Registration #
Basement with plumbing. ❑ Garage ❑ Nvrttberef-Be+#reents -1o Qa-z,so,A sc--6uL
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well o U 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.
um symem im ueen mssaoeo in
wnn applicable North larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
Permit and fonstruction Authorization.
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1. 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:
V. Other. S o.p 9k. -y l_... ti-~: Pa1 , G MZL"..'
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other N t CLG- Gi \ PJ` Septic Tank: 1500 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch a0d feet ditches 3 feet ditches a0~3b inches
French Drain Reauirerl- - ar
Authorized State Agent Date C. 0
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Mite Mad of rat dos Is hom Me NO gads *04k11 OW meek the No 90CM600" qi
d6 a in Innovoiive Wastewater sydom approval IWW=-2002-Wit4or We Cpip
Sub&"ion Iw Rock Appt*yrdo in l ion RNMN,