OPHTE# -,5- a k328 Harnett County Department of Public Health 21 12 9
PERMIT # 1S- 6 oZ.13 Operation Permit
[/New Installation Septic Tank ❑ Repair Q" Nitrification Line ❑ Expansion
PROPERTY LOCATION: c.r lcs-
Name: (owner) KeAeLeA Cv^.-^' ~ SUBDIVISION ifs ~fo.~i LOT # _
System Installer: 0+~- 's ,-,c-k1'.'cf Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 13
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well feet
System Type: 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, files for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961. ,
If. Monitoring: As required by Rule .1961. ~~c 1C q,r
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No V
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sew disposal s stem on ~the above captioned property.
Type of system: ❑ Conventional Oth1 F/0yj Septic Tank: coo gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agen Date & 1A(-W-W 9
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