OP-CANNOT SIGN OFF ON-PERMITS NOT ISSUED PER JBHTE# &-5 -g6y1q Harnett County Department of Public Health 24648
PERMIT # 2 ti5aa Operation Permit
New Installation tic Tank 9 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOfATION: 35(/ —7100 2a- L5/d 150q)
Name: (owner)\1P.n I'a�" c�"5Wester^ SUBDIVISION LOT #
System Installer: Gnz�
irk �nRegistration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public 5?"Well Distance from well /UU .f— feet
System Type: _75;., 5,t,;4'e t 1Types 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
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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 ❑ No EV
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage "posal system on the above captioned property.
Type of system: ❑ Conventional Cher i'2 rl s" > —a:- Septic Tank: I UCD gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z- of each ditch Z U feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent J ��Ti�/_./.1 Date (✓ Zy/ l