OP RHTE# IC- 'S-3t14Cia- Harnett County Department of Public Health 24568
PERMIT # a"Tt�CSS Operation Permit
New Installation Septic Tank X Nitrification line ❑ Repair ❑ Expansion
pp Q PROPERTY LOCATION: C aoo,^`' C -i
Name: (owner) �C I,,P% fie+ �s �s(tLDYc,
IIN C SUBDIVISION Azt,4 V RLty 4G LOT #Z�
System Installer: .A-> In GoL,a Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ CommuniPublic ❑ Well Distance from well feet
System Type: .S �_ 1_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.
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
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
Other.
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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.
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❑ D -Box` O Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above f�p_honedd operty.
Type of syst m: ❑ Conventional Other C'! ao.n t Septic Tank 1 o O o gallons Pump Tank: 1000 gallons
Subsurface of exact length width of depth of
Drainage Field ditches of each ditch 37 ti feet ditches 3 feet ditches aL)— inches
French Drain Reouired;�\ \ ear feet
Authorized State Agent 'N�"�- '--, -Lr
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