OP RHTE# /3-s-.72�_784 Harnett County Department of Public Health 23465
PERMIT # a-2 SO q— Operation Permit
New Installation I� Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: J cJA /J.
Name: (owner) i�4fs ! tiJ¢., ��,-�/ SUBDIVISION LOT # -Z
System Installer: A �kff Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community E2"'Public ❑ Well Distance from well feet
System Type: J_L1 w 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.
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
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rt:nrut LuNuntuns:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
IV
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew disposal system on the abov/� captioned property.
Type of system: ❑ Conventional i�Other 6 v)" c h q �lz"L& &- Septic Tank: / G0gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch G feet ditches feet ditches 12, inches
French Drain Required: Linear feet
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Authorized State Agent,.. /����.l�c'
e�/ Date
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� 2s'78/�