OP RHTE# /5'S — 1&78a2 Harnett County Department of Public Health 23876
PERMIT # ZBsg'L Operation Permit
LT New Installation c Tank 2 Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:5*U90Z (.ol 24
Name: (owner) */,61 SUBDIVISION 7vriv,L LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community d Public ❑ Well Distance from well feet
System Type: 9010 R ZtV jjWjjjaLL4AwapWxpire in S years.
(In accordance with Table V a) Owner y act Health Department 6 m the prior to expiration for permit renewal.
This system has been installed in Compliance with applicable North Carolina Inu eral Statutes, Rules for Sewage Treatment and Disposal, and all
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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.
ply
V
of the Improvement Permit and
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned properly.
Type of system: ElConventional 13� Other 25%fZJnW -rG Septic Tank F -1 o gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 100 feet ditches 3 feet ditches 1A5113 inches
French Drain Reauired: Linear feet
Authorized State AZDate
D�(A�it 1f J Z— o —)S
15-5-3638OR (1)
15-5-3638OR (2)
15-5-3638OR (3)
15-5-3638OR (4)
15-5-3638OR (5)
A
15-5-3638OR (6)
15-5-3638OR (7)
15-5-3638OR (8)
15-5-36380R (9)
15-5-3638OR (10)