OPHTE# 1S-.536)' 0 Harnett County Department of Public Health 23838
PERMIT # X453) Operation Permit
New Installation Ej Septic Tank Nitrification El Repair El Expansion
PROPERTY LOCATION: —767 0¢r.3
Name: (owner) Ae 2.\ L C—1-1Nf SUBDIVISION LOT #
System Installer: he a aY a An QC Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community �K Public ❑ Well Distance from well feet
System Type: �-� Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
cors system has been instaned an compliance with applicable Ranh Carolina General Sutures, Rules for Sewage Treatment and Disposal, and all conditions of the Imp it and Construction Authorimlion.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Role .1961. Other:
Subsurface system operator required? Yes ❑ Noo
IV. Operation:
V. Other.
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Boz ❑ Pump ❑
Following are the specifications for the sewage disposal s stem on the bove captioned property.
Type of system: E) Conventional Other Z �t—ow
Subsurface �No. of exact length
Drainage Field doth r of each ditch ` 5 feet
French Drain Required: _ Linear feet
Alarm ❑
H2OLine ❑
PWR Line
Septic Tank: 1 660 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 11`9� inches
Authorized State Agent Date
&C fF: