OPATE #-14 Harnett County Department of Public Health 23567
PERMIT # �� Operation Permit
New Installation Septic TankNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:jr 1;4
Name: (owner) So Nso SUBDIVISION LOT #
System Installer: L t? iay Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 2 ® ® feet
System Type: a 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.
[his 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
PERMIT CONDITIONS:
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 ❑ N
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.
Els
Type of system: Conventional Other 11<tC. CiA Septic Tank: tO0 Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3b 0 feet ditches 3 feet ditches ;XJ� inches
French Drain eoulre : _ Linear feet
Authorized State Agent �� ��C1 �� Date 1(1