OP RRHTE# WS i5GCLCL Harnett County Department of Public Health 2 3 8 5 5
PERMIT # • LU -103 Operation Permit
New -Installation 'N Se8c Tank �& Nitrification Line ElRepair ❑ Expansion
PROPERTY LOCATION: cc -6 ZD
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Name: (owner) �ytc„p Lymy-L0tV SUBDIVISION lra.o—slSrz5 Q ocE LOT# y�
System Installer. p,•ca_o„wc,r, OrS.r c°°
y 6 S cilr•c6s�Pr,aee,y egistration # 11�'►
Basement with plumbing: ❑ Garage )< Number of Bedrooms -
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well t0Q feet
System Type: �L � 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.
Ims system has been installed in compliance with applicable North Carolma General Statutes, Rules tot Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
1. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above c�aptinned_property.
e
Type of system:
El Conventional
I Other Q V t+t4 S - L^ 2- s
Septic Tank: f AO V gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
dire
exact length
of each ditch 3t� O feet
width of 3 depth of
ditches feet ditches a inches
French Drain Required:
linear feet
Authorized State Agent ����� Date
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