OP RHTE# Harnett County Department of Public Health 23634
PERMIT # bis Operation Permit
New Installation Septic Tank XNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: bovL106Q. O
Name: (owner)' `—�� vii -o i+ac, SUBDIVISION'Ac;5> L.P,,Afl►+A6 e� IPNELOT # IQ
System Installer: P.'Z®pv-z'" SL Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms '
Type of Water Supply: ❑ Community Public ❑ Well Distance from well too feet
System Type: Ll c) 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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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 ❑ 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 Reauired:
Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
sewage disposal system on the abve capt' ed property.
Other CiiP,:t, u- Septic Tank: 1'3� gallons Pump Tank: gallons
exact length width of depth of
of each ditch a.48 feet ditches '3> feet ditches 3�0^a) inches
Linear feet
Authorized State Agent �`.� a Rr�S Date
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