OPHTE# 1 �0-53-1�� Harnett County Department of Public Health
24102
PERMIT # S$<•�t't ,Operation Permit
New Installation �K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
/' PROPERTY LOCATION: O a -o i
Name: (owner) $nom C—ryv+cwiilsvC,,,S SUBDIVISION LOT #
System Installer: EL -I.3 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1100 feet
System Type: _J:Mc. 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 appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (onsmo don Authorization
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
v!
r A � � r10V5G
Q
z
r
7C:
4a a us NJrs
y
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. Sy10is l.anO CGc)NNEGfD V7 C CM %%Cll Lit:
❑
D -Box
❑ Pump ❑ Alarm
❑
H2O1-ine ❑ PWR Line
Following are the
specifications for
the sewage dispos(a�F system on the abav"� c tion roperty.
Type of system:
❑ Conventional
Other �+HAM16y et
Septic Tank
gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
1 of each ditch feet
ditches
feet ditches IB inches
French Drain Retained:
--'ZZbnear feet
Authorized State Agent �� �� ' \\iS Date '71Q%-
1(0 -S--!;-1^1llC'-)