OP RHTE#Q-) -S-)ggS'4q Harnett County Department of Public Health 24522
PERMIT # Operation Permit
New installation�E Se tic Tank' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: sa vas "c,f 65 Gb
Name: (owner) 9-->v%L;0625 lNa SUBDIVISION )iy vri 25 ON a T(— LOT # ea)
System Installer: S cP N s. 2) U)L'ou-L5 Registration #
Basement with plumbing. ❑ Garage �K Number of Bedrooms
Type of Water Supply: ❑ CommunityPublic ElWell Distance from well feet
System Type: 1. o. 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.
Ihis system has been installed in compliance with applicable North Carolina General Smatter, 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.
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System shall perforin 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other S'L FLo.w Septic Tanks C0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc es L of each ditch 300 feet ditches 3 feet ditches a,6 inches
French Drain Required- feet
Authorized State Agent IW15 Date 3
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