OPHTE# 114-3_6" 4 -j Harnett County Department of Public Health 23540
PERMIT Operation Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N�-`��t)5
Name: (owner) -t)oy l �Q—o SUBDIVISION —` LOT #
System Installer: �-A ,>_acLe7_1 -,A Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3>
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t ®® feet
System Type: 5a 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.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
1
IF
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hou�st
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1'Mil LUNDIIIUN):
I. Performance: System shall perform in accordance with Rule .1961.
11. 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
No. of
Drainage Field
ditches
French Drain Reouired:
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sews a disposal system on the above captioned property.
Other C-,,% . �SZ �?u `/ Septic Tank: gallons Pump Tank: % opO gallons
exact length width of depth of
of each ditch feet ditches feet ditches �� "� inches
\ \Linear feet
Authorized State Agent Date I) "A I t5-
1)4- 5- -5 -6 � L4 V,�,