OP RRRHTE#0_7'S' (&t5Q.Q - Harnett County Department of Public Health 24539
PERMIT# 2-�1i—ham Operation Permit
New Installation Septic Tank V Nitrification Line ❑ Repair ❑ Expansion
PROPERTYLO(ATIO: S1Y-P,yas�,,o
r
Name: (owner) CQ'Sa.A toy- qD SUBDIVISION s 91 LOT # I $
System Installer: `v'TP r -%CA — S ,_oct,5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Committal Public ❑ Well Distance from well feet
System Type: 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 system has been installed in compliance with applicable North Carolina General Sumter Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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
Type of system:
specifications for
El Conventional
the sewage disposal system on the above captioned property.
Other QUn14 Co E"Z. a, N-4
Septic Tank: 1000 gallons
Pump Tank: �0 gallons
Subsurface No. of
Drainage Field ditcses
French Drain Reouired: _
exact length
of each ditch 'fib feet
\ n ket
width of
ditches feet
depth of
ditches �Cj_ inches
Authorized State Agent \\1111141_15 Date
0--)-5-n 60522
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