OP RHTE# i(&,-s-3s5gZe- Harnett County Department of Public Health
24396
PERMIT # Z -933o eration Permit-
Installation
ermInstallation TrSeptic Tank Er Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 9'/i OuK c, ,� d 2d i.<d /SZZ
Name: (owner) gobba Lc<A4v4Ny SUBDIVISION LOT #
System Installer: Ll ;A � 1.mSV Registration #
Basement with plumbing: ❑ Garage �❑ "er of Bedrooms NA
Type of Water Supply: ❑ Community L1d"Public ❑ Well Distance from well feet
System Type: ZSiu Types Y and VI Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
INS systems 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.
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PERMIT CONDITIONS:
I.
II.
III.
IV.
Performance: System shall perform in accordance with Rule .1961.
Monitoring: ks required by Rule .1961.
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.
Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewage oral system on the above captioned property.
Type of system: ❑ Conventional Z6 .. UA.cEzoA r"z- F/ew Septic Tank: /OGO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch iso feet ditches 3 feet ditches 3 -! 11 inches
French Drain Required: Linear feet
Authorized State Agent %lamyS
g Date /oe1/toiq—
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