OPHTE# �'S—T'Tt)03 Harnett County Department of Public Health 24736
PERMIT# a1DS Operation Permit
New Installation X Septic TankNitrification Line ❑l Repair F-1Expansion
PROPERTY LOCATION: !i °t 1er 'ycl a1ISo TOy N ZA
Name: (owner) 6 v t2aE SUBDIVISION LOT #
System Installer: l s uty St+oCRC- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _
Type of Water Supply: ❑ CommunitL'�< Public ❑ Well Distance from well SG feet
System Type: .s 1 11:) 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:
III. Maintenance:
IV. Operation:
H be
C1
(V\ V czJc>' 1 so '37 Dvyv
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.
V. Other:
cv6rL ,csu'AiS
I 1 v;.�
nsSPL iON-
SN -L -G>.
❑
D -Boz
❑
Pump ❑
Alarm ❑
H20Line ❑ PWR Line
Following are the
specifications for
the sewage disposal system
on the above
captioned propgrty. `)
Type of system:
❑ Conventional
Other �O"+ems'
G
P.1�43EfL y# Septic Tank:
gallons Pump Tank: IolS� gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditch
5a U feet ditches
feet ditches la, inches
French Drain Reuuiri
\ Linea
Authorized State Apent �V ti-: - Date
b
n
4