OPNTE #I '-1 -� = 3 ;22 7y Harnett County Department of Public Health 23179
PERMIT # 2 '7 -7 r Operation Permit Z �-
E, r New Installation ❑ Septic Tank ET' Nitrification Line ❑ Repair CiExpansion
�, PROPERTY LOCATION:,
Name: (owner) - e SUBDIVISION j� ,� ,_ LOT #
System Installer: o ,c„n Registration #
Basement with plumbing: ❑ Garage ET'Number of Bedrooms 3
Type of Water Supply: ❑ Community 12" Public Ci Well Distance from well S feet
System Type: 45"x% t-a cL 27- es V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Heal th Department 6 months prior to expiration for permit renewal.
This 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
rtKMII LUNUIIIUNS:
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 -Boz , 4� Pump ❑ Alarm ❑ 1`12O1-ine ❑
Following are the ssppecrtati ns for the sewage disposal system on the above captioned property.
Type of system: L ' Conventional Other ? y" e :j'Yy Septic Tank: 'i' gallons Pump Tan
Subsurface No. of exact length width of depth of
Drainage Field ditches 2- of each ditch C, feet ditches 3 feet ditches _
French Drain Required: Linear feet
PWR Line
Tank
Authorized State Age'- �--� +° _(, Date °%
gallons
inches
14 -5- 32774(1) 14 -5- 32774(2) 14 -5- 32774(3) 14 -5- 32774(4) 14 -5- 32774(5)
14 -5 -32774 (6) 14 -5 -32774 (7) 14 -5 -32774 (8)