OPHTE# 121-"5 Harnett County Department
PERMIT #�h�J Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: eta. -mot"
Name: (owner) SUBDIVISION \A 0 \� � �u .,�• LOT # 1 %
System Installer: C Registration #
Basement with plumbing: El Garage Number of Bedrooms
Type of Water Supply: ❑ Communi .Public ❑ Well Distance from well 106" feet
System Type: j 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.
ims system nas been mstauea in compliance witn appttcanie nortn t.arouna eenerat statutes, tomes for sewage treatment ana msposai, ana all conamons of the
r
s.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
IL 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:
rermlt ana LonstruCtton Abtnonzatlon.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal sYstem on the above 6a tione roperty.
Type of system: ❑ Conventional ""� Other l�NA �+m0 � � Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field Ait6ie of each ditch a!S70 feet ditches feet ditches ��^ � inches
French Drain Reauired: _ _Line`�f-eet
Authorized State Agent __ ����, __��\°� \ °0`�� Date ":L
13 -5- 3ao7`�