OPHTE#!�' `�'3W; 6(0 Harnett County Department of Public Health 2390/9
PERMIT # a�-1 13 Operation Permit
New Installation 'K So is Tank X Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: J 0 Q Co c..t_N N s QD
Name: (owner) C� ) OT LJ- 6 C2G Sa= ] J2 SUBDIVISION LOT #
System Installer: Cdc,,S S-5 4* % r—zic-" NAT% Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: Types V and A 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 rompliance with applicable North Carolina General Statutes, Rules for Sewaee Treamem and Disposal and all conditions of the Improvement Permit and construction Authorization
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 ❑ N
If yes, see attached sheet for additional operation Conditions, maintenance and reporting.
IV. Operation:
V. Other. Z ue nPtl Q s' 1 tG;D \a40 SPXtsG vs fErr,
❑
D -Boz
❑ Pump ❑
Fv�,u
5 "r
Following are the
r I
the sewage disposal system on the ahove captioned property.
-�
El
Other G Z �t_or.A
b I 2 r
Subsurface
No. of
A
t � r
width of depth of
Drainage Field
ditches
of each ditch 300 feet
�o E cot^w,�s P„p
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 ❑ N
If yes, see attached sheet for additional operation Conditions, maintenance and reporting.
IV. Operation:
V. Other. Z ue nPtl Q s' 1 tG;D \a40 SPXtsG vs fErr,
❑
D -Boz
❑ Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the ahove captioned property.
Type of system:
El
Other G Z �t_or.A
Septic Tank: T Ct(5 0 gallons Pump Tank: gallons
Subsurface
No. of
\
exact length
width of depth of
Drainage Field
ditches
of each ditch 300 feet
ditches 3 feet ditches Q0 -,3LI inches
french Drain Required: Linear feet
Authorized State Agent Date 41 1% 1 VG
1�-5-���