OP RHTE# A 1-~-cl`~Ll Harnett County Department of Public Health
PERMIT # a~~~b4 Operation Permit 2 2 2 4 2
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: kNc.Z o u c.3;+Lo `RD _
Name: (owner) \4yPccr C-oc45-nrzx)C.:101w SUBDIVISION Sya,c*rE2~~\1_L LOT # _
System Installer: 7-~ ,owso ng Qt-v r•naxn C. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well MP feet
System Type: 7Z~ 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.
This system 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
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' CSR I 3 176
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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: Qu c+~P t ~tt_e+n ►n S,,"- 7v 6E ~Ec Li , . ~S 5 t1
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ca tioned property.
Type of system: ❑ Conventional Other PUr ' a E-Z- f i.yw Septic Tank:
Subsurface of exact length width of
Drainage Field ditches of each ditch "~-4O feet ditches _
French Drain Reauired,-,-.- \ ar t
100 ej gallons Pump Tank: 00 y gallons
.3 depth of
feet ditches inches
Authorized State Agent \\\1. NR1 -14 _ &V'13 Date
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