OPNTE# �'S�°►sl�, Harnett County Department of Public Health 24584
PERMIT # as Operation Permit
New Installation �K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: SPctnr4c 'V-: ,; lu, O2
Name: (owner) Cus %Q0GCbt.4*wp Imc- SUBDIVISION C moL,%NA S6p.7sows LOT # 1�
System Installer: _\ 12>0-1tiw r.1 Registration #
Basement with plumbing: ❑ Garage *W Number of Bedrooms
Type of Water Supply: ❑ ComicsPublic ElWell Distance from well feet
System Type: b 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.
mis system hu been MUM in comphana with applicoble North Carolina General Stamm, 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.
If. 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 cc
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLims ❑ PWR Line
Following are the specifications for the sewage disposal system onntthe above captioned property.
Type of system: 11Conventional Other e. M4 %.e l,it-i Septic Tank: 1000 gallons Pump Tank: 100 t) gallons
Subsurface No. of exact length width of depth of
Drainage Field I L of each ditches feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Q4tr 1Date Gt_"\11
+6-S3ti5���