OP RHTE# o`+ -S"2343.7 fZ Harnett County Department of Public Health 24475
PERMIT # 2G I bs Operation Permit /
12/
New Installation Septic Tank d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONi*t 11-710 ntd] kh9!nzWjn6 2t�
Name: (owner) 7iobbLdEC �654e SUBDIVISION LOT #
System Installer: TZm & ;"1D Registration #
Basement with plumbing: ❑ Garage O 141umber ofBe ms
Type of Water Supply: ED Community O Public YWell Distance from well roo �r feet
System Type: [ VIPA04= G & ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must coma Health Department 6 months prior to expiration for permit renewal.
This 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
...nu wnvn�wna.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
0
Ys
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 sewa a disposal system on the above captioned property.
Type of system: ElConventional (Other 3!0I° R&bUCrtgl.. Septic Tank: I tan oo gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of r
Drainage Field ditches 3 of each ditch f °D feet ditches —3 feet ditches inches
French Drain Required: Linear feet
Authorized State Ag of '--5� Date