OPHTE# )to'S2A1d10 Harnett County Department of Public Health 24110
PERMIT # �$"�3e 1 Operation Permit
New Installation %{ Septic Tank A Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: )—o 4NE ��15OQ
Name: (owner) \Y4Q 5M 1 -NI') CoNx SUBDIVISION P+usst. erv. LOT #
System Installer: T soar '`,Wr))%ARegistration #
Basement with plumbing: El Number of Bedrooms
Type of Water Supply: ❑ Community .K Public ❑ Well Distance from well %fly feet
System Type: � !!- 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 Smmtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consmdon Authonzation.
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PERMIT CONDITIONS
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 ❑ 112O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Sr - T—Lbw Septic Tank: I o O O gallons Pump Tank: gallons
Subsurface No of exact length width of depth of
Drainage Fielddic'he�— of each ditch 5 a feet ditches 3 feet ditches �� inches
French Drain Required: _ \ J.inear feet
Authorized State Agent Date
kr--5-3%663
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