OPHTE# Q~-~~~ I sa Harnett County Department of Public Health 21254
PERMIT 1(~~ Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:. GwGNppt `4I %
Name: (owner} Cry SUBDIVISION ~r L 4toor~ 5 LOT # tom.
System Installer: M~Y-~ Registration #
Basement with plumbing. ❑ Garage V Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 15) 0 feet
System Type:L c 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:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
a46
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other C>IraM~ $,ootcFV,
Septic Tank: jO o p gallons Pump Tank:
Subsurface No. of exact length width of
Drainage Field ditches depth of gallons
each ditch 15 C-) feet ditches 3 feet ditches inches
French Drain Required: _ e, ~r
Authorized State Agent
Date 111116