OP RHTE#t&—a �3 e Harnett County Department of Public Health 24256
PERMIT # 19a Operation Permit /
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOfATIONaCA39`0V*0jn_ lQj
Name: (owner) z; �r 4r�rri,A+--, SUBDIVISION 'Zlra� dam$ _ LOT #
System Installer: lr�t ei . _ Registration #
Basement with plumbing: ❑ Garage V umber of Bedrooms .3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type:pes V and VI Systems expire in S years.
(In accordance with Table V a) Owner must cont a ealth Department 6 months prior to expiration for permit renewal.
[his system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
11. 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 th}, above captioned property.
y
Type of system: ❑
Conventional
13" Other j5y/lsd� �f-sli--
Septic Tank:/00 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditch 2 Yy feet
ditches_ feet
ditches 18 inches
French Drain Required:
Linear feet
Authorized State4g'n�t �bt—.� .111 wnnoDate It — Z, -I b
_e
16-5-39061R (2)
16-5-39061 R (3)
16-5-39061R(7) 16-5-39061R(1)
r[ 4
16-5-39061 R (4)
16-5-39061R (5)
16-5-39061 R (6)