OPHTE# O~'~5 a33}~ Harnett County Department of Public Health 21 4 4 6
PERMIT # Operation Permit
New Installation ';E~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: Pa N z t~s A Vj>
Name: (owner) t_ OS la~r> LLG SUBDIVISION CPrwL-NN o,a5 LOT # `t l
System Installer: ~co '~L)"V4 Registration #
Basement with plumbing: ❑ Garage '1~ Number of Bedrooms 3
Type of Water Supply: ❑ Community -N Public ❑ Well Distance from well \0"21 feet
System Type: - iu 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.
INS 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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PERMIT CONDITIONS-
I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
III. 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. Pv.na ti( cwt- . S t L"T. 6c-- <Z,,4 C' ,C;-,-1i 5 G 10 crt
Following are the specifications for the sewage disposal system on the above captioned prope
Type of system: ❑ Conventional X Other Q~ M~ \ a Psrh~, eptic Tank ! OG 0 gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Sk\ of each ditch tom feet ditches feet ditches _;L inches
French Drain Recuired: _ _ 1ina2r feat
Authorized State Agent_ ~ er-,&s Date 512L do