OPHTE#►3-5-310 Harnett County Department of Public Health 24002
PERMIT # a`b15�1 Operation Permit
New Installation -.4KI Septic Tank �X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION: Hvr)
Name: (owner) KQ..tj'i\ S;-4YcaSx— SUBDIVISION C -i 6-c- T LOT #
System Installer: Qo—r Ghsoy Registration #
Basement with plumbing: ❑ Garage �, Number of Bedrooms .'3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: c Types V and VI Systems expire in S years.
(In accordance with Table Owner must 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 Lonstrucamn Authorization.
D /
4 1 A?'Epfl 1 q 1
f
L
4 �r=,�I i AQ6A ,
\ J
� J
�n
�� NOvsE I �d
PERMIT CONDITIONS
I. Performance:
11. 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 a
maintenance and reporting.
V. Other.
SYS'T F -T n S
+'Lso 'TO is 1—ZR-1 V>_O. VM*-' V"
S` 16 $PA -N
❑
D -Box ❑
Pump ❑ Alarm
❑
H2O1-ine ❑ PWR Line
Following are the
specifications for the sewage
disposal system on the abo eeccapt it property.
Type of system:
ElConventional Other C-- 4 aBQ1_ WE"N
Septic Tank: DDO a
gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of
3
depth of
Drainage leditches
L
of each ditch 3 OO feet
ditches
feet ditches ►8-30 inches
French Drain ReauirwL
Jdnear feet
Authorized State Agent Date
13-5- )I 0a,()