OPNTE# I6-5—"ICsA Harnett County Department of Public Health 24722
PERMIT # ag30o Operation Permit
New Installation �X Septic Tank �)< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: SQS 0s..R.n- (�tr-T
Name: (owner) Cs tna t_f� Q�z.Ea SUBDIVISION LOT #
System Installer. C wC,-tAW 6 Ccowxmo--"0tr Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well 100 feet
System Type: 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 Stamies, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
2EP4s(z
9ZGa,
9,01 rwe,�
6 to ooaE
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NO)<
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
00 L'sc 1)rc
or n ovCsan-Y
❑
—D -Box ❑
Pump ❑
Alarm ❑ H2OLine LlPWR Line
Following are the
specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional \64
Other E'2 VLAw
Septic Tank: 1600 gallons Pump Tank: gallons
Subsurface
No. ofexact
length
c-0
width of depth of
3
Drainage Field
1
of each ditch feet
ditches feet ditches — inches
French Drain Require
linear feet
Authorized State Agent �� At' Date Z
16- 5 - 40li33