OP-Z it 11'8 ~ IV71
HTE# f - 34KZ Harnett County Department of Public Health 23200
PERMIT # i `7 3-' Operation Permit
Z New Installation L� Septic Tank Nitrification line ❑ Repair ❑ Expansion
`� PROPERTY LOCATION: 14 �4 F �
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Name: (owner) -il�`", 1� SUBDIVISION -5Fe r--,d s LOT #
System Installer: r Registration #
Basement with plumbing: El Garage Number of Bedrooms 3 �nd Type of Water Supply: ❑ Community Public ❑ Well Distance from L \conditions
System Type: T %c fl --'—t Type5 years.
(In accordance with Table V a) Owner must ontact Health D art to expiration for permit renewal.
This system has been installed in compliance with applicable Nor Carolina General Statutes, Rules for Sewage Treatment and Dispo ae 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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional E�' Other t S;4s Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches ^ � feet ditches U ' inches
French Drain Required: Linear feet
Authorized State Ag Date ®Y S - i�
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N
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44
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14 -5 -32852 (12)
14 -5 -32852 (13)
14 -5 -32852 (14)
14 -5 -32852 (15)
14 -5 -32852 (1)