OPHTE#1(a-5--Ai 0a. Harnett County Department of Public Health
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PERMIT #A-243 Operation Permit 2 1-7
New Installation �K Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: Sossta `4 ,4eg. Yz
Name: (owner) E c c_ wog c s SUBDIVISION —' LOT # 1
System Installer. Oo a Registration #
Basement with plumbing: ❑ Garage )ij Number of Bedrooms 3
Type of Water Supply: ❑ Communi .o Public El Well Distance from well feet
System Type: _1 - o. 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
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PAIR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other '6ZCI_esw Septic Tank: 1000 gallons Pump Tank gallons
Subsurface Noof exact length width of depth of
Drainage Fii stds s F of each ditch feet ditches 3 feet ditches 3 W inches
French Drain Requg near feet
Authorized State Agent tea_ �V �-t 94)15 Date
41,
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