OP RNTE# \u —�'"� \ �ilgZ Harnett County Department of Public Health 2 4 4 4 5
PERMIT # '.A -6 \ 58 Operation Permit
%�Q New Installation IR Septic Tank�l Nitrification Line El Repair LJExpansior
PROPERTY LOCATION: VQ7ooy— MAtic L, R
Name: (owner) G Gv ca - o SUBDIVISION LOT # a.
System Installer: L F�czn-j 5,i a --L.? G Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms_
Type of Water Supply: ❑ Community )' Public ❑ Well Distance from well 1(20 feet
System Type: 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.
Iris system has hen installed in compliance with appliable North Carolina General Statutes, Aides for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authoriation.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes F-10
If yes, see attached sheet for additional operation cc
maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captioned properly.
Type of system:
El Conventional
Other —TIa�. G�rs?5
Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface
N. of
exact length
width of depth of
Drainage Field
ditches
of each ditch a� feet
ditches 3 feet ditches I-8 914 inches
French Drain Required:_
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Authorized State Agent Date
411