OPHTE# 1 O-s-a3~ Harnett County Department of Public Health 2 0 8 4 9
PERMIT # Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: Vj)
Name: (owner) _\vICc>.r~n, CJcv. Co , ~N c SUBDIVISION Su~sc~ LOT # 2iC
System Installer: N~`kE SiMexzJ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms .3
Type of Water Supply: ❑ Community , Public ❑ Well Distance from well ICO feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
mis system nas 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.
11. 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:
Following are the specifications for the sewage dispos~stem on the above captioned property.
Type of system: ❑ Conventional X Other -J sQjz- CN\ cp Septic Tank: 10 0 o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a- of each ditch 5 feet ditches 3 feet ditches Ig - 3a inches
French Drain Required e\ t,., 4-
Authorized State Agent er--,-k5
Date 41C+110
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