OPF --
PERMIT
G
HTE #SS" 5-'�� (O Harnett County Department of Public Health 23821
PERMIT# a�Q35 Operation Permit
New Installation Septic TankNitrification Line ❑ Repair F-1Expansion
PROPERTY LOCATION: ocr�
Name: (owner) S o �; n S c Q �+ SUBDIVISION N "'r sLz, "v FF LOT # `}`b
System Installer: Registration #
Basement with plumbing: ❑ Garage 'K Number of Bedrooms [-
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: G 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 applicable North Carolina General Statutes, Rules for sewage Treatment and Disposal, and all ca ditions of the Improvement Permit and Conswaion Authorization.
PERMIT CONDITIONS:
I. Performance:
If. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ 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 X Other 1--2— V7a_ow Septic Tank l oo C1 gallons Pump Tank gallons
Subsurface No. of exact length .p width of depth of
Drainage Field It 3 of each ditch 9() feet ditches 3 feet ditches R'S G inches
French Drain Reouired:tlear feet
Authorized State A¢ent VQ -N5 Date It
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PERMIT CONDITIONS:
I. Performance:
If. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ 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 X Other 1--2— V7a_ow Septic Tank l oo C1 gallons Pump Tank gallons
Subsurface No. of exact length .p width of depth of
Drainage Field It 3 of each ditch 9() feet ditches 3 feet ditches R'S G inches
French Drain Reouired:tlear feet
Authorized State A¢ent VQ -N5 Date It
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