OPHTE# It, —5"-378 5t, Harnett County Department of Public Health 24032
PERMIT # 28(�BS' Operation Permit
New 'Installation c Tank Y/Nitrirication line ❑ Repair ❑ Expansion
PROPERTY LOCATION: fh1 LIZ
Name: (owner) �� k� h%a�o SUBDIVISION l-ck h' /5;1, v LOT # z
System Installer. Registration #
Basement with plumbing: ❑ Garage ,Number of Bedro3
Type of Water Sup III . ❑ Community [it Public ❑ Well Distance from well feet
System Type: 6`•Y� j�3� lh/da G r✓Zuxi/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.
been installed in compliance with applicable knh Carolina General Statutes Rules for Sewage Treatment and Disposal and all conditions of the Impmvement Permi4d (monition Authorization
PERMIT CONDITIONS:
1. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for the
sewage disposal system on the above captioned property.
Type of system:
❑ Con tonal
❑ Other Z�'%6/L�ii� D crz-�—�
Septic Tank: 10 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
Is
depth of
depth
Drainage Field
ditches
of each ditch Gb feet
ditches
ditches 20 inches
French Drain Required:
_ et
Authorized State Agent V 5 Date
16-5-37856 (1) 16-5-37856 (2) 16-5-37856 (3) 16-5-37856 (4) 16-5-37856 (5)
9- \1
-h +�141
04
1
J
16-5-37856 (11) 16-5-37856 (12) 16-5-37856 (13) 16-5-37856 (14) 16-5-37856 (15)
i
16-5-37856 (16) 16-5-37856 (17) 16-5-37856 (18)