OP RHTE# 11 -x -5-33Q73 K---, Harnett County Department of Public Health 23756
PERMIT # a'�� 1 Operation Permit
New Installation '5k Septic Tank )?" Nitrification Line 0
Repair ❑ Expansion
PROPERTY LOCATION:'T's>_or-, Mo -"i,4 6TON Ct+—
Name: (owner) SPwy lAor'Nr_-s Nr -Ac— SUBDIVISION Mor. Qicu_ 2A96E LOT #��
System Installer: M-C� )'j SCR- ', y Registration #
Basement with plumbing: ❑ Garage>< Number of Bedrooms �_ t
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well s 0 () 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.
MIS system has been insmuea m mmpuante wan appbcabie norm tarmma eenem smures, nines for sewage rearmens no uisposm, no au commom m me
W 01
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 cx
's1a-oeN 1 o iN G SD + p --
maintenance and reporting.
Mk]
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system ;,the above captioned property.
Type of system: El Conventional X Other PVmP'So SZ5-j. o -W Septic Tank: 1 00 (5 gallons Pump Tank 100 O gallons
Subsurface No. of S exact length width of depth of
Drainage Field dirt — of each ditch 50 feet ditches 3 feet ditches 1� inches
French Drain Requirez Linear feet
Authorized State Aeent yw5 Date L