OP RRHTE# 1(�,- Harnett County Department of Public Health 24450
PERMIT # Operation Permit
New Installation 1�t Septic Tank V Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: Doss Ro
Name: (owner) Kamp62L-j C ft \FCC— SUBDIVISION LOT # 3
System Installer: l o e try Co LES Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms ti
Type of Water Supply: ❑ Community Public ❑ Well Distance from well %60 feet
System Type: i ti 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.
INS system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treabnem and Disposal, and all conditions of the Improvement Permit and (instruction Authorization.
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
111. 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
Other GZ Sr L
Septic Tank: 1 O O O gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
es
1 of each ditch 460 feet
ditches 3 feet ditches l�— inches
French Drain Required:
Linear feet
Authorized State Agent Date
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