OP RHTE# j-5-aL'RC6-4rz_ Harnett County Department of Public Health 24836
PERMIT# 2`11aa4:q Operation Permit
L,."New Installation 2 Septic Tank 9- Nitrification Line ❑ Repair ❑ Expansion
\ PROPERTY LOfATION: toriI &alc�re� 2.\4 Cs(t— 1434)
Name: (owner) f`suc r% wiz Zr �e SUBDIVISION C>r:,�1on� sAa LOT # IQ42o
System Installer: 'T o ma.6 AV : 1 cam Registration # 1914
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community g-Fublic ❑ Well Distance from well r 4 feet
System Type: °., . n S - Types V and A Systems expire in S years.
(In accordance with Table V a) Owner m st contact Health Department 6 months prior to expiration for permit renewal.
this system has been installed in compliance with applicable North Carolina General Stances. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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PERMIT CONDITIONS
I. Performance:
II. 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 ❑ No 9�—
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal
system on the above captioned property.
Type of system:
❑ Conventional 2'lther f��
z/oil
Septic Tank Iyod gallons Pump Tank: w✓I gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 5
of each ditch PX_' feet
ditches _ 3 feet ditches al inches
French Drain Required: Linear feet
Authorized State Agent (_ _ _ _ ��-- �� �i f'S Date 0 C,51901A
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