OP RNTE# S�'�'—s�3`�� Harnett County Department of Public Health 25022
PERMIT # 9a y SS Operation Permit
New Installation � Septic Tank '�< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t aJ-s GQ.% lie v ti Rn
Name: (owner) pa u L SUBDIVISION — LOT # —1,
System Installer. IL—a2ti) 4;NVL Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L -f
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: =CY c„ 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 sptem 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
I'MiI LUNI IIUN6:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional `5� Other E'2.. 1;1 a4DW Septic Tank: l O o v
Subsurface No. of exact length width of
Drainage Field ditches S of each ditch 3S0 feet ditches
H2O1-ine ❑
PWR Line
_ gallons Pump Tank: gallons
depth of
feet ditches 11.3 0 inches
French Drain Required: Linear feet
Authorized State Agent %;4� Date 3� 1`<
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