OPHTE# 14 �� 33 Harnett County Department of Public Health 23291
PERMIT # )6 Operation Permit
1 New Installation Ls' St(?q Tank �< Nitrification Line El Repair ❑ Expansior
l PROPERTY LOCATION: EK2- L-oof'
Name: (owner) C P�—% F-5 1.7 ` G G SUBDIVISION \4P5 -% LA�n,,Dw c Q. \��� 5u. ,n-N"5 LOT # IC-
System Installer: F--,Dv > G- Q� UR Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 5
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 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
YtKPII l IUNUII IUN):
I. 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 ❑ Na`
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box ❑ Pump ❑ Alarm
❑ 1-12OLine ❑ PWR Line
Following are the specifications
for the sewage disposal system on the above captionet( property.
Type of system: ❑
Conventional X Other 1D cwt- (�` J
Septic Tank: 1 gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of exact length
ditches of each ditch is feet
width of depth of
ditches feet ditches o�� °a0 inches
French Drain Required -ti \ feet
Authorized State Agent _ '`��, \ a') Date 5
1�t- 5 - 33 ®°tl