OP RRRHTE# Harnett County Department of Public Health 24521
PERMIT #c�'$`13� Oueration Permit
New Installation V Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -S i -ens 1igyEs Psi
Name: (owner) o ,tri ,UoeXJ2) SUBDIVISION _�iy vssLb o� LOT # l6
System Installer: .rvNvNG.1t_ 16 y�+oCSL5 Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: SSi 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.
inns system ha been installed in compliance with applicable North Carolina General Statuses, Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and ConstmNon Authoriation.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
It. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
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 sewage disposal system on the above captioned property.
Type of system: El
Conventional �
Other 9'r ;7 c
Septic Tank: loos
gallons Pump Tank 100 0 gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Fiel
ditches t
of each ditch QL6 0 feet
ditches 3
feet ditches inches
French Drain Required:
Linear feet
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Authorized State Agent - � w c6t+5 Date