OP - can not sign off in HTE have not purchased permit for poolNTE# ,s--� =3 , t3 y Harnett County Department of Public Health 23813
PERMIT # 'LI1s? Operation Permit �/
❑ New Installation EI Septic Tank C? Nitrification Line EI Repair L7 Expansion
PROPERTY LOCATION: -2v a i7
Name: (owner) 12.)S SUBDIVISION LOT #
System Installer: '! — Registration #
Basement with plumbing: ❑ Garage62'11 11 tuber f Bedrooms 3
Type of Water Supply: ❑ Community C public ❑ Well Distance from well feet
System Type: +' 6 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) IfOwner must contaU Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applitablel North Carolina General Statutes, Rules for Sewage Treatment and
I. Performance:
ll. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
and all conditions of the Improvement Permit and Construction
VNCr_ I�errs,ay
NC—r,> rho a l /L%" Leers t l s' a F�
6� boNvn. Suh,tiQ i�td4e-,.11t„)�
To 4
'304SY7 Cac:tA4--,�4 C*kf t2b
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewagS disposal system on the above captioned property.
Type of system: ❑ Conventional EY Other i5'?. (beQ�.._s 1� Septic Tank: rSo gallons Pump Tank: gallons
Subsurface No. of exact length / width of depth of
Drainage Field ditches _� of each ditch Sb feet ditches feet ditches 22- inches
trench Drain Required: Linear Net
Authorized State eQ��Date 10 —30 — d
F
15-5-37134 (2) 15-5-37134 (3) 15-5-37134 (4) 15-5-37134 (5) 15-5-37134 (1)