OP RHTE# / Y-0— - 3331 1Y22 Harnett County Department of Public Health 23953
PERMIT # a:?2Y 2 Operation Permit
Z/�New Installation O✓ Septic Tank Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATIO : i : + sp^ .41
Name: (owner) S� a nc : l B�=IatA J SUBDIVISION �wF J f �o:.i LOT # 131
System Installer. JAr—Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ,.3
Type of Water Supply: ❑ Community Ir Public ❑ Well Distance from well feet
System Type: :ZT—q 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 appliable North Carolma General Statutes, 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.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No Eer
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 sew disposal s stem on the above captioned property.
Type of system: ❑ Conventional Other L lot,..> Septic Tank: Oo U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches / of each ditch %Z VU feet ditches J feet ditches !�°'c2 / inches
French Drain Required: Linear feet
Authorized State Ag �a.�,/<Cf�� Date A40/
q.s-��i77/L