OPHTE#1o-s•a3~ Harnett County Department of Public Health 21370
PERMIT # Operation Permit
New Installation ~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: ?yN"LegE Ca _ w 'qz
Name: (owner) t SUBDIVISION ~>,,An. ~~~--cot~rza LOT # 4
System Installer. ~~c.2 txn--,zc- ct- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a _
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well feet
System Type: ❑ Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
finis 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:
11. Monitoring:
III. Maintenance:
IV. Operation:
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 co
maintenance and reporting.
V. Other. Sy5~6r,. ~vsp£t.S6t~ a.t cj $ 10 'Ttt~ G,.os trlEa~ 10 ~ p ~51,,,~ S rte
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional NZ~ Other Toc C""'e5 Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of ` exact length width of depth of
Drainage Field ditches [ of each ditch 10o feet ditches -3 feet ditches - )t' inches
French Drain Reauired: h l in iu`d~ C\
Authorized State Agent ey-,NS Date -9 1 t~ I td
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