OPATE# Harnett County Department of Public Health 23026
PERMIT # a-.: �a- 3 Operation Permit
New Installation X Se tic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 0 c„6
Name: (owner) c..i�.EE. bs�F� 1.. -C- SUBDIVISION 00. �.ON LOT #
System Installer: C- c� ,,o Registration #
Basement with plumbing: ❑ Garage ' Number of Bedrooms H
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well ®G feet
System Type: 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.
]his 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
PtRMIl CUNUIIIUNS:
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage dispojgI system on the above captioned pro erty.
Type of system: ❑
Conventional
Other Ufa ) c) �` IANS1 12_ d Septic Tank: 1( 0
gallons Pump Tank: 10 Q V gallons
Subsurface
No. of
exact length width of
�
depth of
Drainage Field
ditct.
1 of each ditch d�4 feet ditches
feet ditches ,'�� inches
French Drain Reauired:
Linea]
Authorized State Agent !�N_ I- , ,�10 Date
13 -5 "3I 5-.IIS