OP[ITE# c~ s =~oz ( 6 Harnett County Department of Public Health 20701
PERMIT # J5I EV6 Operation Permit
New Installation `E4~pttiic Tank El Re air Nitrification Line ❑ Expansion
PROPERTY LOCATION: R y ^Q-A- Ie-te_z_e
Name: (owner) A o r4 Me_ 1-C 5 Ci y SUBDIVISION j C~s~c►. croc 99 LOT # C
System Installer. Registration #
Basement with plumbing ❑ Garage 02" Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public VWell Distance from well ~t~ feet
System Type: 7Q~Cr- 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 Trea ant and Disposal and all conditions of the h
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PERMIT CONDITIONS: It"t
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Permit and Cousin Won Authorization.
Following are the specifications for the sew a disposal system on Ihe above captioned property.
Type of system: ❑ Conventional Other CZ or-/. W Septic Tank: 00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 26
Drainage Field ditches of each ditch 01-0 feet ditches feet ditches I inches
French Drain Required: Linear feet
Authorized State Agent > Date
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