OPHTE# Harnett County Department of lic Health 23312
PERMIT #"�� 0 eration Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: -
Name: (owner) �\ r v i3'-cL L-u G SUBDIVISION LOT #
System Installer: ) z,, 'z�) m Q$ v f �,oES� Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms L
Type of Water Supply: ❑ Community Public ❑ Well Distance from well IC)() 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
rtill'111 IUIVUI I IUN3:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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: S-/ S - I— C_ �A.. 12iCsy"o®n r-k0M&
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above a tioned operty.
Type of system: ❑ Conventional Other C_" C>-, 2 (-n� Septic Tank: L�C?�O gallons Pump Tank: gallons
Subsurface f exact length width of depth of
Drainage Field ditches of each ditch 3,4 Q feet ditches feet ditches 3Z aO inches
French Drain Reouired:�'!s ae et
Authorized State Agent ___ 9GIA5 Date C
L1� -S - 3�)35>