OP RNTE# 07 — 5 1 MS'Q Harnett County Department of Public Health 24912
PERMIT # a`�oo?. Operation Permit
New Installation R Septic Tank )d Nitrification Line ❑ Repair ❑ Expansion
C� PROPERTY LOCATION:_ S s s p5 Vl "ES RnZFiNG
Name: (owner) S11, ) L-01511.5 \0 c SUBDIVISION Hv tneas Pot N—V LOT # 3q
System Installer C --YS 4r+c.i L., g v a L—or-93 Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Comm sim Public ❑ Well Distance from well feet
System Type: I 0 Types V and VI Systems expire in 5 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 Starnes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conmuction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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 sewage disposal system on the above captioned property.
Type of system: El Conventional Other Ez V1. ow Septic Tank: 1450 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Fi itches 1 of each ditch 300 feet ditches 3 feet ditches S a inches
French Drain Required: Jinear feet
Authorized State Agent W;Aoi Date -1
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