OP Rca� Harnett County Department of Public A 23529
PERMIT # 0- (6-73 Operation Permit
New Installation A Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Cot f
Name: (owner) `E>v\G,a= SUBDIVISION Wg:fsa Sut cns- LOT # 155
System Installer: C= -o' E. C-Naa.-is'� Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms .5
Type of Water Supply: ElCommunity �M Public ElWell Distance from well 100 feet
System Type: _—I -v7& 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 Larohna General Statutes, Rules for Sewage Treatment and Uisposal, and all conditions of the Improvement rermlt and Lonstruction Autnonzanon.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface
Drainage Field ditches
French Drain Required:
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the ab o a capti ed property.
Other �-s3Am� Septic Tank: 1C -Q gallons Pump Tank: gallons
t exact length width of depth of
of each ditch tit feet ditches 3 feet ditches inches
r feet
Authorized State Agent �'�� �����''��\ _ -4 - __ Date