OPHTE# 1 G-5- 3%34% Harnett County Department of Public Health 24108
PERMIT #3�1�b2 Operation Permit
New Installation 74S� Septic Tank 'U Nitrification Line ❑ Repair ❑ Expansion
\ PROPERTY LOCATION: oD DCL
Name: (owner) ��1Zc� �`0n^ s3 SUBDIVISION Oast O LOT # T`''f
System Installer. Registration #
Basement with plumbing: ❑ Garage 5� Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well !00 feet
System Type: `-�—i1—'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 Noah Carolina General Smwtas. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Lonstrumon Amhonaatlon.
� 1
} A
t
R�
)tovs
D
r
ti
WGaa'`tSy(61z, W o v0 n (,L
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field tches
French Drain Required:
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the above captioneVprope
Other u' � _ �W'n6C�t, y' Septic Tank: 1 Dori gallons Pump Tank: ib6d gallons
exactlength width of depth of
L of each ditch a6o feet ditches 3 feet ditches 1E inches
n Linear feet
Authorized State Agent ��-) Date 8 3)1) C