OPHTE# I®�= % "���T2. Harnett County Department of Public Health 22536
PERMIT # v Ot� �1 Operation Permit
New Installation �R Septic Tank �` Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: &1P2Cs,5 cz4
Name: (owner) '� tQ ;da.-s o i� G SUBDIVISION Q- wg-4 -S ¢'o� C;,. LOT # 1
System Installer: 'tea �o ta-c� 1� GwS Registration #
Basement with plumbing: ❑ Garage '�R Number of Bedrooms H
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1O 6 feet
System Type: ...j Types V and VI Systems expire in 5 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system oPp,,.the above captioned property.
Type of system: El Conventional Other V r„ 4 \ 0 —2 L-Ory Septic Tank: 10 0 0 gallons Pump Tank: LO 0 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 84.0 feet ditches 3 feet ditches inches
French Drain Reouired: _ ineNeet
Authorized State Agent Date � -O »t Y2-
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