OPHTE# /�.5�=.3feOS 0 Harnett County Department of Public Health
23929
PERMIT # a6a90 Operation Permit
ZNew Installation Septic Tank R�Nitriffcation Line ❑ Repair ❑ Expansion
` PROPERTY LKATION: Ra l��A Po i-j rA, 4.^,
Name: (owner) (fa . PeAci:. w. C� .�+��i'•�a SUBDIVISION LOT #
System Installer: 9:ddlc Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms .3
Type of Water Supply: ❑ Community (public ❑ Well Distance from well feet
System Type: ZZ a 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 Statures. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 -Box ❑ Pump ❑ Alarm ❑ 1`1201-ine ❑ PWR Line
Following are the specifications for the sewage"disposaLSystem on thy above captioned property.
Type of system: ❑ Conventonal E � Other �jO. tIt z/ hn„d¢r Septic Tank: as gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 000 feet ditches feet ditches / 6 0 inches
French Drain Required: Linear feet
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Authorized State Age w>- Date ZZ ! 2 z 2 a e,,,—
44,
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