OPHTE# IL4 —S- Harnett County Department of Public Health 23298
PERMIT #� Operation Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: MNgv—' s
Name: (owner) pi-� `� �v�`F2v �,� tlA.1 SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well 1 C00 feet
System Type: t 1 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
PERMIT CONDITIONS:
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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other '=t2q- Septic Tank: t® ®Q
Subsurface No. of exact length width of
Drainage Field ditch of each ditch feet ditches
French Drain Reauired: feet
Authorized State Agent t`���� b? G—.�5 Date C
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches tAll a inches
� �'� _' �-- 335�,�