OPHTE# I 't1459t-1 Harnett County Department of Public Health 24895
PERMIT # 2`167 O Operation Permit
New Installatio6" 4 Se tic Tank X Nitrification Line ❑ Repair ❑ Expansior
((�� PROPERTY LOfATION: l N`v6,4 Ls -s
Name: (owner) Qs.ju—Ty�c�q v50nf 11vmt;5 SUBDIVISION GLOT # �- C
System Installer. C.0 , G sa ti GrL Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms_
Type of Water Supply: ❑ Community Public EJWell Distance from well feet
System Type: a j i � 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 Sumtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (ammo ion Authorization.
V
30
PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
Type
specifications for
❑ Conventional
the sewage dispos'7I� system on the above captioned propert
J
)
of system:
Other `omp OCAAc„t)e,C.Z (,Rvi.�:. Septic Tank: 160
r
gallons Pump Tank: (00 CI gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
L of each ditch a'A O feet ditches 3
feet ditrhec lii mus i.rtio.
French rain Required: linear feet ......
Authorized State Agent ttdsj� Date