OP RHTE# i r5-30 7Z3R Harnett County Department of Public Health 23767
PERMIT # a'13 N'S Operation Permit
New Installation Septic Tank >� Nitrification line ❑ Repair ❑ Expansior
PROPERTY LOCATION: S%aE pito 02 %-? C_
`
Name: (owner) SSa aay `�or�[ g N c_ SUBDIVISION 4Zt_.t,,j cikr^5 LOT # 51
System Installer: 1-icNsiAz,,ir.s E iaG Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L-!
Type of Water Supply: ❑ Community i Public ❑ Well Distance from well L CDC)' feet
System Type: Types V and VI Systems expire in S 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 appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
5
4, N
A2LR ,F \ C
C.C.
E s
13
Zor
4
c
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Max
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. 1Pa..Vrn6\,af. SKvaoFa i� — A'i S) cr_�cazKM LoteT°n V7ep-onn (.a°v Pussu NC5
Pav%," Qt T, ir 1, aSt:+i-i.S�i ioN
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: E3 Conventional AI Other C ---Z, 7s-6 w Septic Tank 100 C gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc � of each ditch (yd feet ditches 3 feet ditches I'9 -_;LL) inches
French Drain Required Linear feet
Authorized State Agent 'i_15 Date 10116I)f
0
I "OFEM
13- 6-3 C-
I
13- 6-3 C-