OPHTE# o~►-a~sy06 Harnett County Department of Public Health 21 3 21
PERMIT Operation Permit
New Installation A Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: M baY5
Name: (owner) ~3~.Ac Kw~„ 1~t ~,Es fir, L SUBDIVISION ASYsG~av~~ LOT # 103
System Installer: ins 5-c2,•c_y-U-P 4p Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community 1K Public ❑ Well Distance from well feet
System Type: ti 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.
ims 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 CONDITIM-
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 ❑ NOA
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other.
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other hrnP-To F-'Z„ F't,.ow Septic Tank: tt7C90 gallons Pump Tank: ►bd d gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch 1,60 feet ditches 3 feet ditches inches
French Drain Required: Gnpar feet
Authorized State Agent 7-L»s Date
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