OP RHTE# /7-5— J/`/3%Z Harnett County Department of Public Health 24772
PERMIT # 3%% Operation Permit
9 New Installation LV/Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION•OLZZ/3— fi9�r s. i; �,� 11146
Name: (owner) (; �e� (,.�g, 1 _ _ $Nc— SUBDIVISION /`(�LOT # S—
System Installer. /e0./ ffllj� lj Registration
Basement with plumbing: ❑ Garage Edi umber of Bedrooms ,3
Type of Water Supply: ❑ Community fd Public ❑ Well Distance from well feet
System Type: pes V and VI Systems expire in S years.
(In accordance with Table Y a) Owner most contact Health nt 6 months riot to expiration for permit renewal.
This system has been installed in compliance with applicable Nonh ca lin. Geneal Starnes Rules for Sewage Treatment and Disposal, and all conditions of the 1 provement Permit and construction Authorization.
PERMIT CONDITION!
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
2e172,
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._5 #-CA vJ A
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
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the se a disposal system on the above captioned property.
Type of system: ❑ Conventional OtherZ� )C,'� Septic Tank: / 0 6 6 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of / �7
Drainage Field ditches of each ditch 30o feet ditches —3 feet ditches inches
French Drain Required: Linear feet
Authorized State �nt c' P L&2%/(.,,i9) LL/ -- Date
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17-5-41143R (1) 17-5-41143R (2) 17-5-41143R (3) 17-541143R (4) 17-541143R (5)
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All
17-5-41143R (6) 17-5-41143R (7) 17-5-41143R (8) 17-541143R (9) 17-5-41143R (10)
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4 _ 3
17-5-41143R (11)-- 17-5-41143R (12) 17-541143R (13) 17-5-41143R (14) 17-5-41143R (15)
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17-5-41143R (16) 17-5-41143R (17) 17-5-41143R (18) 17-5-41143R (19) 17-5-41143R (20)
17-5-41143R (21) 17-5-41143R (22) 17-5-41143R (23) 17-541143R (24) 17-5-41143R (25)
17-5-41143R (26) 17-541143R (27) 17-5-41143R (28) 17-5-41143R (29) 17-541143R (30)
17-541143R (31) 17-5-41143R (32) 17-541143R (33) 17-541143R (34) 17-541143R (35)