OPNTE# 1 % - S-'4I TDt� Harnett County Department of Public Health 24586
PERMIT # QL'I S03 Operation Permit
XNew Installation 'X Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: S ae�as�clse ti L
Name: (owner) gAz�,vno� G oe —z sa tt: Z SUBDIVISION LOT # I
System Installer. L—e a "N -7K;i)+N-bQN Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms L-
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: _—_yG Types Y 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 imtalled in compliance with appliabie North Carolina General Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improeemem Permit and Construction Authorization.
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional open
IV. Operation:
Other:
1961.
conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional '�54 Other E-2-
Fio tir Septic Tank: 10 b O gallons Pump Tank gallons
Subsurface % of exact length width of depth of r�
Drainage Field ditches of each ditch Z "110 feet ditches 3 feet ditches o711 inches
French Drain Required: Line
Authorized State Agent Date
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