OP RHTE# I I- S-_ L169312 Harnett County Department of Public Health 24676
PERMIT # Operation Permit
❑ New Installation ❑ Septic Tank ❑d Nitrification Line ❑ Repair Pff anion
PROPERTY LOCATION:1
Name: (owner) � 41k £y�U& 3 b -S SUBDIVISION LOT #
System Installer: T'a A k Registration #
Basement with plumbing: ❑ Garageubedrooms
Type of Water Supply: O Community [2 ' -Public ❑ Well Distance from well N% feet
System Type: 1:,c T . ca—v- 5K-rr- 't 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.
Ibis system not Deen Installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authomation
rcnntl wnunluns:
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Others ,r.>, n e Septic Tank: /Qcx= gallons Pump Tank: NJA gallons
Subsurface No. of exact length width of depth of
Drainage field ditches ^' of each ditch '"" feet ditches vet feet ditches ^' t'l inches
French Drain Required: Linear feet
Authorized State Agent Date O P I r7 ti lg o I-4
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rcnntl wnunluns:
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Others ,r.>, n e Septic Tank: /Qcx= gallons Pump Tank: NJA gallons
Subsurface No. of exact length width of depth of
Drainage field ditches ^' of each ditch '"" feet ditches vet feet ditches ^' t'l inches
French Drain Required: Linear feet
Authorized State Agent Date O P I r7 ti lg o I-4
EMT
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