OP RHTE# J -i -> Harnett County Department of Public Health 23046
PERMIT # Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1 I t4 � sv ' E <g
Name: (owner) i P+ i L V Clioa-,> SUBDIVISION QQ.-i°yc s► P(a LOT #
System Installer: C=D a Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 40 a 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.
This 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
PERMIT CONDITIONS:
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 ❑ NoO
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 disposal system on the above captioned operty.
Type of system: ❑ Conventional ; Other C--,A *nS� - �'►' Septic Tank: t o b Q) gallons Pump Tank: 1 O Q 0 gallons
Subsurface-__ No. of exact length width of depth of
Drainage Field drtt 1 of each ditch a (3 0 feet ditches feet ditches inches
French Drain Reauiredl,-,- } Linear feet
Authorized State Agent ������ ' �' Date 1 � 1 t i t
13- S -30 V30 a-