OPHTEA6'S-L\0465 Harnett County Department of Public Health 24462
PERMIT # ;ao13G Operation Permit
❑ New Installation ❑ Septic Tank X Nitrification Line ❑ Repair Expansior
c _\ PROPERTY LOCATION: 'Yll E 4.o
Name: (owner) 964q_ELLA\V, aR i 1Jar o SUBDIVISION w -ay Rcz g LOT # -1
System Installer: Mog1I-E cyv CC5- Registration # 30I
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms L—
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: „r 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.
MIS system has been installed in comphanre with applicable North Carolina General Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorisation.
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PERMIT CONDITIONS
I. Performance:
It. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other. V`r40Tti aT 10 NI C_'t.Ah`
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captionedproperty.
Type of system: ❑ Conventional Other _Ca—�o.�na✓E2 CC'�Li' )) Septic Tank: Q,r\5 i \r.l G gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field t4 ' ditche 0 of each ditch 6 5 feet ditches 3 feet ditches inches
French Drain Required:_ Iirwar feet
Authorized State Agent 'Nssk�, 'V%y Date
16- 5 -Li 01-� bS-