OPHTE# 1(--53b56 7 Harnett County Department of Public Health 24093
PERMIT # Operation Permit
V New Installation 'R Septic Tank ) Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: "(14 .,
Name: (owner) Y�a r ,5 SUBDIVISION V7_T5)-) M , -etJ LOT # 3—
System Installer: IFty r` Cos) erTY Gp r4" Registration #
Basement with plumbing: ❑ Garage El Number of Bedrooms
Type of Water Supply: ❑ Community � Public ❑ Well Distance from well 100 feet
System Type: "S 1 _. Types V and A 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 Statutes, Rules for Sewage Treatment and Disposal. and all conditions of the Improvement Permit and Construction Authoruation
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PLRMII CUNDITIM:
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 cc
IV. Operation:
V. Other.
maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sewage
disposals stem on the above captioned property.
Type of system:
❑ Conventional Other 2 �Lb� 7
Septic Tank IO® O
gallons Pump Tank gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches 1
of each ditch 450 feet
ditches
feet ditches .Zi inches
French Drain Required:
LIN4acfeet
ria
Authorized State Agent :!�� Date -7 1-1t►4
16-S-3'855