OPHTE#_1 Harnett County Department of ublic Health 23392
PERMIT # '�.'�`yt�; Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: )oC5'
Name: (owner) u x)A SUBDIVISION fl,-<�o LOT # 100
System Installer: , y !s `� 5�t tc,�- 1—R•N� Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: �7 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.
Ims system has been installed in compliance with applicable North Carolma General Ntatutes, Nules for )ewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
B ISO nt L. N
PLKMII LUNDIIIUNS:
1. 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 ❑ N
If yes, see attached sheet for additional operation coriditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional I Other yen?-1 G Septic Tank: tt 0 0 gallons Pump Tank: i ®C� � gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch -L4n feet ditches 3 feet ditches I — 4il inches
French Drain Reouire&,_ near feet
Authorized State Agent Date