OPHTE #,'-�° S - 5%a(0 Harnett County Department of Public Health
23410
PERMIT # D:'8 0 N Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansior
_ PROPERTY LOCATION: K�kvM -' , 9-,s> Name: (owner) d try L. O L, "'S -JLY)t>\ SUBDIVISION w LOT #
System Installer: C>rN g C -W% v, vcLa p 4 Registration #
Basement with plumbing: ❑ Garage �< Number of Bedrooms _
Type of Water Supply: ❑ Community )< Public ❑ Well Distance from well 1 tQ feet
System Type: =yr b Types V and VI Systems expire in 5 years.
(In accordance with Table V a) -JR Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system has been instaneo in compliance with applicable North larolina beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
2�M R1
rtnril l 4UNUI I IUNS:
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 ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal, system on the above captioned property.
Type of system: ❑ Conventional Othe, 0 E'2 - Septic Tank: l ®O0 gallons Pump Tank: 1-000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 8G C) feet ditches 3 feet ditches I'Z-�4 inches
French Drain Required: Linear feet
Authorized State Agent Date 10 1�
14 - 5.33�o6