OPNTE#) -)" 5'Ltor.1) Harnett County Department of Public Health 24590
PERMIT# oZ°ti4OG Operation Permit
New Installation X Se tic Tank *>< Nitrification Line E]Repair ❑ Expansion
PROPERTY LOCATION:_ o: asst osA910
Name: (owner) Qa V l - SUBDIVISION LOT # 3
System Installer. Lr c"—) Srk L Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms 4
Type of Water Supply: ❑ Comum X Public ❑ Well Distance from well feet
System Type: � 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 Nordi Carolina 6eneml statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
I
4
D
R
PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoXI
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the �sewyage disposal,_s)'stem on the above captioned property.
Type of system: ❑ Conventional `( Other GZ �t.G�J' Septic Tank: s Ci Q gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field `ditds 3 of each ditch 6 feet ditches 3 feet ditches �1M ��,t"l inches
French Drain Requl Linear feet
Authorized State Agent - : (t*)15 Date C
Flp F i
t
s
a 4e h
fi , 2
� E-
<j�i-�
4
't
i
ii
Y;