OPHTE# Harnett County Department of Public Health 20851
PERMIT # a5°I~o~ Operation Permit
New Installation ~ Septic Tank ❑ RepairX Nitrification line ❑ Expansion
PROPERTY LOCATION: F0'OFQn Q,D
Name: (owner) V-r-4,., l) N o , oet9 SUBDIVISION b~ ocrrs~o Nc LOT # 5`1JN
System Installer: LPn1 S hp,czQE Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well ~0 U feet
System Type: Types V and VI Systems expire in S 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 ap icable 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:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other `~~26 G~~PS Septic Tank: ~bCjO gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch a~ O feet ditches 3 feet ditches 001 inches
French Drain Required--~., faa,-
Authorized State Agent Date
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