OPNTE# 16—5--S`►4oq Harnett County Department of Public Health 24308
PERMIT # a'1C0�i Operation Permit
New Installation XSe tic Tank � Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �A�g^WcaasA Cz-
Name: (owner) 1tic, SUBDIVISION LOT #
System Installer: marts Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms H
Type of Water Supply: ❑ Community Public ❑ Well Distance from well VtC feet
System Type: 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.
Ims system has been msulled In compliance with appllable Noah Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consnusuon Authorization
ll
6 \
P �
A �
Roast
D
2
yc
G
s 4�aaaaAh �
rinrn s.unumum:
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 X Other E?_7a_o%, Septic Tank gallons Pump Tank: gallons
Subsurfaceexact length width of depth of
Drainage Field ditchesCtan of each ditch g feet ditches s feet ditches � inches
French Drain Reouire�\ � et
Authorized State Agent tner c Date
7
r'f'1