OPHTE# I %-51R)-1 b Harnett County Department of Public Health 24103
PERMIT # %-L—T 1, Operation Permit
I New Installation V Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION:
Name: (owner) 1-rEvG. )Na MAS SUBDIVISION — LOT # 3
System Installer: 1—mca; r 5"o tp0, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: —TS ¢ 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
I
E I
1—ioUSE
D
a
t
C
l—.a..r0.6�+cG QP
rxmvn s.vnunmras:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
Other %-z � cvw
Septic Tank: 1000 gallons
Pump Tank gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches
l of each ditch 30 0 feet
ditches 3 feet
ditches inches
French Drain ReQuir4A6
feet
Authorized State Agent Date