OPHTE# I S S- 3-77-Z Harnett County Department of Public Health 24055
PERMIT # Z �s73 Operation Permit
L9' New Installation 13K Septic Tank & Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:" ac)
Name: (owner) % rl)-b e,a.e'n. *otJ SUBDIVISION LOT #
System Installer. C 1154 T- AP,4 its Registration #
Basement with plumbing: ❑ Garage / Number of Bedrooms q
Type of Water Supply: ❑ Community fJ Public ❑ Well Distance from well feet
System Type: Ctr Jyfe. 14,-- d i3 Gni+ el 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 srstem has been installed in compliance with applicable North Carolina
sal, and all conditions of the
1_
N
fv�
Permit and construction Authorization.
PERMIT CONDITIONS: o
V
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961. Y
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maiNgikenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: 2r Conventional 10' Other Septic Tank: IDD & gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /So, feet ditches feet ditches le inches
French Drain Required: linear feet
Authorized State AfeaL�-:P .12— Date L 8-1 Io
15-5-37224 (1)
15-5-37224 (2)
15-5-37224 (6)
15-5-37224 (7)
15-5-37224 (3)
or
15-5-37224 (8)
15-5-37224 (4)
:,� tw
15-5-37224 (5)