OPHTE# 3'A- -s 36`x® Harnett County Department of Public Health 23408
PERMIT # Operation Permit
New Installation'—"K Se tic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: QuL.oC -sue ��.
Name: (owner) 'N'SQ u1 L- aE2 �sv C- SUBDIVISION �C^s� f-- Q+HSay.,e, Q. � � Svc-m- -� LOT # 6�?
System Installer: Registration #
Basement with plumbing: ❑ Garage>< Number of Bedrooms -5
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well 10C1 feet
System Type: _. - -1 c, 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 Larolma beneral )tatutes, Rules for )ewaRe Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
s
NtKM11 LUNDII1UN):
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 ❑ NYN
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
maintenance and reporting.
I E53 '
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capt ed property.
Type of system: ❑ Conventional Other C.uaNN� �1�� Septic Tank: l8E0— gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 2,®0 feet ditches feet ditches o»'3 inches
French Drain Required: Linear feet
Authorized State Agent Date
ILi-5 -33G--Qoo