OP RRNTE# I I- 5- Zk"' q- Harnett County Department of Public Health 24291
PERMIT# 2i`A1u0 Operation Permit
New Installation )�l Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Cys %N! SM N LN t:hT Qo
Name: (owner) C oe.,FotiZ \-�omc* �N L SUBDIVISION FooEs-�C�rz P f 5 LOT # IM
System Installer. q V SsEL 9" , 4 5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public El Well Distance from well IOd feet
System Type: cIC) 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 has been installed in compliance with applicable North Carolina General Smmten, Rules for Sewage Treatment and Disposal, and all conditions; of the Improvement Permit and construction Authorization
rtNMlt LuNunwN):
I. Performance:
Il. Monitoring:
111. 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 operati cc
maintenance and reporting.
❑
D -Boz
❑ Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage dispoj� system on the ave ca �oned property.
Type of system: ❑
Conventional
� Other �--.1�,e�8Gli_4�—
Septic Tank: 40017
gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of
3
depth of
Drainage Field—
ditches _�_ of each ditch feet
ditches
feet ditchestQ a� inches
French Drain Required
Linear feet
Authorized State Agent 'WN�� "e�\tom tow Date
11-- 5- -D� 6Lj 6` Tz(z-.