OPHTE# 1y-s-3g1r0 Harnett County Department of Public Health
23930
PERMIT # ab lo,r Operation Permit �/
f� New Installatio�P c Tank L Nitrification Line ❑ Repair ❑ Expansion
' 1 PROPERTY LOCATION: —c'r Rd.
Name: (owner) wJ/AA ConrfrU42't J SUBDIVISION 72-osc -crf jC:all oe LOT # J6
System Installer: 7'9% - c.J el., 6%wo Registration #
Basement with plumbing: ❑ Garage ❑ Number of BedroomsJV
Type of Water Supply: ❑ Community C?Public ❑ Well Distance from well feet
System Type: 7IL o 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 conditions of the Impressment Permit and Construction Authorization
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PERMIT
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewM(disposal Ystemon the above captioned property.
El of system: Coof CCA16 t 1 Septic Tank: 000 gallons Pump Tank gallons
Subsurface No. ofexact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches Aff inches
French Drain Required: Linear feet
Authorized State Age Date ///o/ 6
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