OPHTE# IL4 �' � ���Harnett County Department of Public Health
23624
PERMIT # �'� Operation Permit
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Ks -"T v c.x7t _ y ZN
Name: (owner) Y c'4rr nt s2.v C..; 1 es N SUBDIVISION tier c,� Gfz� ' .�®�� LOT # t-("
System Installer: -i e7ct as its L - y rv-,5NN P- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms S
Type of Water Supply: ❑ Community Public ❑ Well Distance from well lOO feet
System Type: 1 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 Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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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 ❑
Following are the specifications for the sewage disposalR stem on the above ca tioned property.
Type of system: El Conventional Other Yu felt- V-0— Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches of each ditch S feet ditches
French Drain Required: -.._ Linear feet
1-12O1-ine ❑
PWR Line
gallons Pump Tank: 1000 gallons
depth of
feet ditches inches
Authorized State Agentr\` ��\ __ Date qi �) I )_:
i) -i -5 3-L)15L-)