OPHTE# Iy -s - .3yogs Harnett County Department of Public Health 23335
PERMIT # i ? 01; 3 —/ Operation Permit
2 New Installation Y Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,;&�_/yc ,/ —'So 20
Name: (owner) 1��l�ss� ST%- �i`�`�SdO SUBDIVISION —� LOT #
System Installer: ►Z'a Y C&bh gjc kl4t2 Registration #
Basement with plumbing: ❑ Garage ❑ mber of Bedrooms
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well feet
System Type: `� 'tom �2 V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner mus ai 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
rtKMI I I.UNUIIIUNN:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
lv y,
W �1 $
G Z 5 :4
LA
tt -,Z
O
twuta9 a
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 conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewie disposal system on the above captioned property.
Type of system: ❑ Conventional CJ Other r$°-' Septic Tank: 40 y D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ditches 3 feet ditches Z® y $ inches
French Drain Required: Linear feet
Authorized State Ageit /'— %•'g --��. Date