OPHTE# ILf— -Z 1-7 J Harnett County Department of Public Health 2330
PERMIT # �-�� ®� . Operation Permit
New Installation Septic Tan Nitrification Line F-1 Repair F-1 Expansion
PROPERTY LOCATION: t t_ ecji �2�sosG
Name: (owner) N y G }� �ucZ2 —G� SUBDIVISION y")K� LOT # -�-
System Installer: • s —5—N xru Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -1
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 0 C3 feet
System Type: 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
I' Mil CUNUIIIUNS:
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 ❑ No4
IV. Operation:
V. Other:
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
St-2-F-0 Fo"' 0 -S
❑ D -Box ❑ Pump ❑
Following are the specifications for the .s�ew5age disposal system on the above captioned property.
Type of system: ❑ Conventional ex Other Vi10 w
Subsurface No. of exact length
Drainage Field _diTttres -. . of each ditch d feet
French Drain Reouired: _ \ �r feet
Alarm ❑ H2O1.ine ❑ PWR Line
Septic Tank: Q. 0 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
Authorized State Agent_ �!!�`1�kaa7 Date 6
t " -5 - `jz.°-1 3