OPHTE# Harnett County Department of Public Health 23976
PERMIT # Operation Permit
New Installation �K Septic Tank 12� Nitrification Line ❑ Repair ❑ Expansion
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PROPE RTY LOCATION: NtJ%QCEo.e„ "aJAy
Name: (owner) iJ%L .xgcg' Iron. , ttoC. SUBDIVISION�lHor.Do N\aNaL LOT # r)
System Installer:�>_A r�Q Registration #
Basement with plumbing: El Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well T OIZ) feet
System Type: mi� b 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 North Carolina General Statuses, 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.
If. 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 a
IV. Operation:
V. Other.
T
3 p'
N o us6
D
R
1
G
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLimf ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional .� Other TV m9'1 o G, -2— Fx.�,�,r Septic Tank: tp0(l' gallons Pump Tank: 4000 gallons
Subsurface No. of exact length width of depth of
Drainage Field d'e 4 of each ditch 6 0 feet ditches 31 feet ditches 1K '3-,4 inches
French Drain Required: w�diLlear feet
Authorized State hent Date