OP RHTE Harnett County Department of Public Health 23051
PERMIT # '� 1 S ✓, Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair El Expansion
t PROPERTY LOCATION:
Name: (owner) N C-0 nsSCLV US 10 ig SUBDIVISION 1,.,y Ls mac _ LOT # CS
System Installer: __1'r4 p<j ; Q As PLLV crca \ N�, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Com ,. Public ❑ Well Distance from well V QO 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.
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
rtKiiii CUNUIIIUNY
I. Performance:
11. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage dispos I system on the above captioned property.
Type of system: ❑ Conventional X Other U rte' a - ' 1po#a Septic Tank: S G ®d
Subsurface No. of exact length width of
Drainage Field ditches of each ditch A 6 ® feet ditches
French Drain Required: ar feet\
Authorized State Agent \i�y� \ 9.&))5 Date k
H2OLine ❑
PWR Line
gallons Pump Tank: t COQ gallons
depth of
feet ditches k ° 9 inches
13- �= 3�►�.�6�