OP RNTE# 15'5Harnett County Department of Public Health 23848
PERMIT # �E'�G OOperation Permit
New Installation '�k Septic Tank �X Nitrification Line ❑ Repair ❑ Expansion
�� PROPERTY LOCATION: .�, of Coc.v-1vs
Name: (owner) COL -t-' N% t Nc Z-� k 1 SUBDIVISION LOT #
System Installer: X06 ay 1s.o,P�5 Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well ya0 feet
System Type: i> > Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Amhoriaation.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: I cf," FC�64vCN Ov"N'� 1NSao.y-`pp
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned proper.y
Type of system: 11 Conventional Other 9')fnWTo (_j sam(, NLoy-) Septic Tank: 100 tv gallons Pump Tank: S60 Cl gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: _ ar feet
Authorized State Agent Date
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