OPHTE# 51 cid Harnett County Department of Public Health 23524
PERMIT # Operation Permit
Nev,-irrst Septic Tank ❑ Nitrification Line X Repair ❑ Expansion
PROPERTY LOCATION: GAS 1Q9
Name: (owner) �i F iw G2 �CvE] aQ MC
t.» SUBDIVISION LOT #
System Installer: �'3-��g S n4*L•c.,,tP\tQ�) Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .�
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 5d feet
System Type: 1;�) 6-� 1 +J 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 in compliance with applicable North Carolina General Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the Improvement rermit and lonstructton Autnorizanon.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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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.
ip,ssL
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field�itrlt�s of each ditch feet
French Drain Required: _\ Linear feet
Alarm ❑
H2O1-ine ❑
Septic Tank: %0C)Q/ gallons Pump Tank:
width of depth of
ditches feet ditches
Authorized State Agent u--ItS5 Date
PWR Line
gallons
inches