OPHTE# o~-s~a~ Asa Harnett County Department of Public Health 2 0 7 9 5
PERMIT # 53 3 Operation Permit
New Installation X Septic Tank ❑ Repair'X Nitrification Line ❑ Expansion
PROPERTY LOCATION: H0 aYG-0
Name: (owner) SUBDIVISION PL a-* t-moo 4 LOT #
System Installer. an r► Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well b0 feet
System Type: =00D 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.
Ihis 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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PFRNIT fAIdnITIAMG
1. Performance System shall perform in accordance with Rule .1961.
II. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other 1P,+ ~ Lwcs Cs~C~- D &I crC Pwr.a E Qs.Pll.r, SsI1-j--5'0 I~B. C.~ ,QED
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other ?L^W %c7
Septic Tank: to o b gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3 ab feet ditches 3 feet ditches N - QL1 inrhnc
French Drain Required: Linear feet
Authorized State Agent ' j Date ~~4ci 0
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