OPHTE# Ira 5-'5 1 Harnett County Department of Public Health 241 1 8
PERMIT # a.�i`►LI Operation Permit
New Installation A Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
` PROPERTY LOCATION: gam az-, La
Name: (owner) �rt: �'�SN n U—v-"-j SUBDIVISION LOT #
System Installer. L gcMr—) )P*qR Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 4
Type of Water Supply: ❑ Community < Public ❑ Well Distance from well feet
System Type: = la, Types V and VI Systems expire in 5 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 ends applicable North Carolina General statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
fzr f
� P '
A i
1 �
i
HOME
U
--F
ro
pAT %s iil GU TLD
rtKMII LUNa111Unb:
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No�N
If yes, see attached sheet for additional operation a
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other EZ-'�s.,p I Septic Tank s 60 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field I of each ditch 3O4 feet ditches 3 feet ditches IV --:LLA inches
French Drain Required near feet
Authorized State Agent��\ 1.v --� ve'cliil-S Date
- - ;�:
�, �' ri.:
�;
,•�,.
i J