OPHTE# 14 -'5-�3 Harnett County Department of Public Health 23391
PERMIT # a���C Operation Permit
New Installation V Se tic Tank �d Nitrification Line El Repair El Expansion
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PROPERTY LOCATION: A I -L
Name: (owner) mm!5 SUBDIVISION M ^y.,aN LOT # 40 �
System Installer: o'\ C G v,<.ac n.- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well l00 feet
System Type: Q 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 incompliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PLKMII CONDITIONI:
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface
Drainage Field ditches �
French Drain Reauired:.,.
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage dispoisai system on the above captioP property.
Other >�C� � w i 'J Septic Tank: gallons Pump Tank: gallons
exact length width of depth of ^� Q
of each ditch aNO feet ditches feet ditches inches
Authorized State Agent --, \� ?ZW Date