OPHTE# L5 -15-3G333 Harnett County Department of Public Health 24592
PERMIT # 2"i33°'t- Operation Permit
❑ New Installation ❑ Septic Tank %< Nitrification Line ❑ Repair �<Expansion
PROPERTY LOLATION: tis \1, a:ora go c) -4 NY
Name: (owner) Gon-9 SM X "H SUBDIVISION a o z-vap S c_.o.So N1 LOT # �a
System Installer. J u t_i .w S u yA_saaD Registration #
Basement with plumbing. ❑ Garage 1!5( Number of Bedrooms Lf
Type of Water Supply: ❑ CommunilPublic ElWell Distance from well feet
System Type: \ S I a Types V and VI Systems expire in 5 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 Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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 ❑ NOR
If yes, see attached sheet for additional operathin co ditions, maintenance and
reporting.
Q
Y. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
o.
S{ r US6.
Type of system: ❑
Conventional Other Cv,saat+e&L
Septic Tank: b enK W
C gallons Pump Tank gallons
Subsurface
T
width of
depth of
36
Drainage Field
l:
ditches 3
feet ditches inches
French Drain Require
0
7
4
v
L
wll.-O `N Oaf WY�Y
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 ❑ NOR
If yes, see attached sheet for additional operathin co ditions, maintenance and
reporting.
IV. Operation:
Y. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captionecL property.
'Nrl
Type of system: ❑
Conventional Other Cv,saat+e&L
Septic Tank: b enK W
C gallons Pump Tank gallons
Subsurface
No. of exact length
width of
depth of
36
Drainage Field
dit of each ditch 5 O feet
ditches 3
feet ditches inches
French Drain Require
Linear feet
Authorized State Agent p6w-' Date 61 Y
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P'+
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