OPHTE# o~s-a3% 05 Harnett County Department of Public Health 21 4 3 3
PERMIT Operation Permit
> New Installation Septic Tank 0 Repair Nitrification Line 0 Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION lip o~ PQ, t;ZT~ LOT # 1
System Installer: f- ~,cuLy Sza e.~r P Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms -3
Type of Water Supply: ❑ Community ;P!~\ Public ❑ Well Distance from well ~(DO feet
System Type: ~1> 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.
Ihls 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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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No Jam'.
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage dispos I system on the above captioned property.
Type of system: ❑ Conventional Otheru mP \ (~Z- Few Septic Tank: 1000
Subsurface No. of exact length width of
Drainage Field ditches , of each ditch a_Q65 feet ditches
French Drain Reauired: _ `~linaa
gallons Pump Tank: ibaG gallons
depth of
feet ditches a inches
Authorized State Agent Date 515 h0
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