OP RHTE# 0 JJ t'?_4 7.f Harnett County Department of Public Health 19 9 01
PERMIT # 'N A-1 `l Operation Permit
New Installation ~9- Septic Tank ❑ Repair' )ZI Nitrification Line ❑ Expansion
PROPERTY LOCATION:_ I I\-
Name: (owner) SUBDIVISION ~~.2 z >t f LOT # 2 Z
System Installer. z', 0
u Rijn -3 Registration #
Basement with plumbing ❑ Gana e J0 Number of Bedrooms _
Type of Water ~pply~ Community Public ❑ Well distance from well S ` J feet
System Type: I 1 rt ^ ~j - t, 4 tl~v Types Y and VI Systems expire in 5 years.
(In accordance with Table Y a) er must contact Health Department 6 months prior to expiration for permit renewal.
Ims sptem nas oven nnraeo m compiana mm appwcaou Rorie Carona uewm )Unties, auks for ktrap Treatment arid
1~
Maury Munrtrnur.
v
1. Performance: System shall perform in accordance with Rule .1961. Z0
II. Monitoring As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No,4-
H yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Y. Other.
Following are the specifications for the sewage disposal tem on the above capti oned property.
Type of system: ❑ Conventional 16 Other &"A _ Size of tank: Septic Tank: jJ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch :V-)-) feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Agent C~v 11, Date d l
and all coi d a m of the Improrenmn Permit and fommidon hAonzaow
s.