OPHTE# 15- 5-3b-) Harnett County Department of Public Health 23864
PERMIT # 9ZiS l S Operation Permit
New Installation -JR Septic Tank 'K Nitrification Line ❑ Repair ❑ Expansion
,�/t PROPERTY LOC . eo
ATION: �asip
Name: (owner) r`1ac),\o t tONSJrrr,& SUBDIVISION Oaae,,6 I1cas< LOT #D
System Installer: L-ow,sc- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ;K Public ❑ Well Distance from well 1 b O feet
System Type: =fir 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.
This system has been installed in compliance with applicable Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
i
�P LC -0 eJ 12,.9
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoIX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other
Subsurface No. of exact length
Drainage Field ditches of each ditch a.�0 feet
French Drain Required:. _ inear feet
Alarm ❑
H2OLine ❑
PWR Line
Septic Tank: 100 0 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 113 a\ inches
Authorized State Agent�a`��\%� o4ti*S Date