OPHTE# E�-�uaT�� Harnett County Department of Public Health 25050
PERMIT At a•°12)L1 Operation Permit
New Installation rK Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: 33g R,Vfa/L
Name: (owner) Moss Hom6ac.o6as SUBDIVISION LOT #
System Installer. N a— G. -,c 'Mo 5j, Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well S feet
System Type: w Types V and VI Systems expire in S years.
(In accordance with Table Vable V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been imtelled in compliance with applicable North Catalina General Statutes, Rules for Sewaee Treatment and Disposal, and all conditions of the Improvement Permit and rnnstrueinn authnmatlon
PERMIT CONDITIONS:
ate—,
I. Performance:
System shall perform in accordance with Rule .1961.
d
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other.
Hovsk
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
R
V. Other.
1 Q
❑
D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
E IV
Type of system: ❑
Conventional � Other G11Pfa,9C'rZ_ a 141 Septic Tank: 106 0
I
Subsurface
Drainage Field
No. of exact length width of
ditches _� of each ditch 1a0 feet ditches 3
depth of
feet ditches A'A', inches
P 1 E
I l
2 �
, f
�H.GA
n.,
PERMIT CONDITIONS:
I. Performance:
System shall perform in accordance with Rule .1961.
11. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
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 ca tion" roperty.
Type of system: ❑
Conventional � Other G11Pfa,9C'rZ_ a 141 Septic Tank: 106 0
gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of exact length width of
ditches _� of each ditch 1a0 feet ditches 3
depth of
feet ditches A'A', inches
French Drain Required: ` Linear feet
Authorized State Agent R6j5 Date
I
aV
G 1
41'
L
v
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lam.