OPHTE# / I- S-- a-?S_? Q Harnett County Department of Public Health
PERMIT # a ~,O 7 -7 Operation Permit 2 21 6 0
12 New Installation Ca' Se S". Tank d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: s xvk
Name: (owner) ~,NaIA A ~n5_1r 'kQ3 SUBDIVISION -T-r-- t{- /-.r ~ cog e LOT # ~ 8
System Installer: T_~s,r_6 P r R Registration #
Basement with plumbing: ❑ Garage ft~ umber of Bedrooms
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: LT b 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.
finis system nas peen mstaiea in compuance wan appncame Nortn Lamina uenerai matures, Hies for sewage treatment ana utsposai, ana an conammns or me improvement rermit ana tonstrucnon Authorization.
~^ca
.iq _
l~
I 3 5 (a pJQe~ `Sys+cc-
~I r `a
t
P pa~.v f ,n
P"j
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew a disposal stem on the above caption d property.
Type of system: ❑ Conventional Other en's cZ~71 W Septic Tank: Of rJ '3 gallons Pump Tank: /00 0 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches -2- of each ditch /00 feet ditches J feet ditches 30 inches
French Drain Required: Linear feet
Authorized State Agent a. Z"-&c Date 2~ (moo f~
V~ 8'7()