OP RHTE# o,I -5-650c" Harnett County Department of Public Health 19924
PERMIT # a~33o Operation Permit
New Installation 'K Septic Tank ❑ Repair 0 Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) `~ou r ~Ess.<~ a~N SUBDIVISION Mr_t_ecsy LOT #
System Installer. OT,-, STR~c u-.~9 Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community '19 Public ❑ Well Distance from well SdC~ feet
System Type: __11 b Types V and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
this s tem has been snsWW in compliance with apokabk North Cxokm Gen" Smtutes, Nsdes for Sewap Treatment and Disponl, and aN conditions of the Improvement Pemat and ConsmKdw Audwizaiw
~`SA
T t.ap `16J
! CA KV~rf :t U"~AV I
FLd ~ -
I
Ll
R
V
E
4ov.+n5 W w
PERMIT CONDITIONS-
1. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No~
H yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: V Conventional ❑ Other Size of tank: Septic Tank: I~Ob gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 5 of each ditch `I b feet ditches 3 feet ditches aLi -3(3 inches
French Drain Required: _ Linear feet
Authorized State Agent Date i I av