OP RHTE# I--s-a3 Harnett County Department of Public Health 21 4 6 9
PERMIT # 2.5~bG1 Operation Permit
New Installation A Septic Tank ❑ Re airX Nitrification Line ❑ Expansion
PROPERTY LOCATION: LP%SW 'r,_4&
Name: (owner) NS oss o h,L ~j L g,S SUBDIVISION _ \ a~c•, t-c Ga o,r LOT # 4
System Installer: _ Lo"r.AvE Son,-, Ns q ,J Registration #
Basement with plumbing: ❑ Garage' Number of Bedrooms 3-
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: rr. 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.
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ' Other F-Z Septic Tank: 100 gallons Pump tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 450 feet ditches g feet ditches 18 inches
French Drain Required: tao~
Authorized State Agent_ 0-M 5 Date 5