OP RHTE# 12—s :4?P 1,P` Harnett County Department of Public Health 24357
PERMIT # Operation PerMit
NeW Installation 2rSeptic Tank Nitrification Lie ❑ Repair ❑ Expansion
PROPERTY LOCATIONzr1L_/7d/ z �. > 'eC
Name: (owner) � 44 /')NCZ4 SUBDIVISION a LOT # -Z–
System
System Installer: i Registration #
Basement with plumbing: ❑ Garage ❑ tjus66er of edrooms
Type of Wat"� upply: ❑ Commu�mry Pub' ❑ Well Distance from well feet
System Type: T �z1k,01 0 %/ sa � . Types V and VI Systems exoire in S rears.
(In accordance withrTable V a) (fviner must contactealthDepartmen�ths prior to expiration for permit renewal
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MIS system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal and all conditions of she Improvement Permit and construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
It. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal system on othe abovj captyii �ed property.
Type of system: ❑ Conventional Other � ejgwt Ii 1� Septic Tank: Z20d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of „
Drainage Field ditches �_ of each ditch 36 d feet ditches �_ feet ditches /00 inches
French Drain Required: Linear Feet
Authorized State Agen <::f Date /0 "3l—
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12-5-29256R (1) 12-5-29256R (2) 12-5-29256R (3) 12-5-29256R (4) 12-5-29256R (5)
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12-5-29256R (6) 12-5-29256R (7) 12-5-29256R (8) 12-5-29256R (9) 12-5-29256R (10)
12-5-29256R (11) 12-5-29256R (12) 12-5-29256R (13) 12-5-29256R (14) 12-5-29256R (15)
AWL A&
12-5-29256R (16) 12-5-29256R (17) 12-5-29256R (18) 12-5-29256R (19) 12-5-29256R (20)
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12-5-29256R (21) 12-5-29256R (22) 12-5-29256R (23) 12-5-29256R (24) 12-5-29256R (25)
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12-5-29256R (26) 12-5-29256R (27) 12-5-29256R (28) 12.5-29256R (29) 12-5-29256R (30)
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12-5-29256R (31) 12-5-29256R (32) 12-5-29256R (33) 12-5-29256R (34) 12-5-29256R (35)