OPHTE# IG -5 Harnett County Department of Public Health 24530
PERMIT # 1 Operation Permit
New Installation '�R Septic Tank'' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC,_X1
Name: (owner) FE'ACf_— NA-Os'� SUBDIVISION — -� s - st: Po y N7C LOT # 16
System Installer. 1Z) G C-caQ57 Elt, Registration #
Basement with plumbing: ❑ Garage 'R Number of Bedrooms 3
Type of Water Supply: ❑ Ca! uni 4R� Public ❑ Well Distance from well \ OO feet
System Type: v , 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 to compliance mth applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authoruation
--- — I a
1
�aovSE
0
2
J
L,
YtNMII LUNUIIIUN):
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 cc
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional �< Other E.ZFLctiw Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface exact length width of depth of
Drainage Field ditches of each ditch a3 0 feet ditches 3 feet ditches inches
French Drain Reauireds, r feet
Authorized State Ascent X315 Date