OP RHTE# 11- S—c{ 23�SOQ Harnett County Department of Public Health 25032
PERMIT # W77 -) Operation Permit
New Installation �'X Septic Tank �K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Docs ?_n
Name: (owner) i *" C4 SUBDIVISION c) LOT # 157
System Installer. C1i1 ss Sat.,,,Registration #
Basement with plumbing: ❑ Garage )% Number of Bedrooms
Type of Water Supply: ❑ Commit it,� A Public El Well Distance from well feet
System Type: �� 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.
ims system has been metalled in compliance with applicable Nonh Carolina General Statures• Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Consmudion Amhonution.
NOUsE sS
❑y
I�5 q L
D
R
s • _ — I
I 1
( R6P•h i2
I gszP A 1
EX�GRIS IV G P¢,.
rcmmi cunuinuna:
I. Performance:
It. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Noel
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal syste� on the above captioned property.
Type of system: ❑ Conventional .(7 Other FR—L -tr..e Septic Tank: %600 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches I of each ditch 3'db feet ditches _ feet ditches tg inches
trench Drain Required• Linear feet
Authorized State Agent -115 Date 314 1'8