OPHTE# 0:. --`-> 31 >6 �- Harnett County Department of Public Health 23859
PERMIT # 9.'2kA J- Operation Permit
New Installation A Septc Tank X Nitrification Line 13 Repair El Expansion
�y `, "14
i PROPERTY LOCATION: 22fsr %A .-+v
Name: (owner) 1 Vc•-i,C:l- 14C't•1Cs> SUBDIVISION C� LOT # Q
System Installer: ny', � C_ G (A,i, , a is o 11 Registration #
Basement with plumbing: El Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: i c , Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
this system and; been installed in compliance with applicable North Urolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construaion Authorization
IICv,�
YtRMIl LUNDI1110ft
I. 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 ❑ No>
If yes, see attached sheet for additional operation ca
IV. Operation:
V. Other.
maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above Pc ptioned pra��leny.
Type of system: ❑
Conventional
Other �tAD,, iZ, ,1 `C'y�J
Septic Tank 1001 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditch
_
of each ditch ,9 "" r) feet
ditches feet
ditches�l�'� inches
French Drain Required:
Linear feet
_
Authorized State hent ��, �. �`' kCC—N5 Date
15- 6- -Y-) 3�-&,