OPHTE# `0'5'--XS"?A33 Harnett County Department of Public Health
PERMIT # Operation Permit 21 791
Tank Nitrification Line ❑ Repair ❑ Expansion
New Installation ~ SeaNa'v')
PROPERTY LOCATION: Name: (owner) )1A Va~z •53 ~cra•5 CL- "'e SUBDIVISION WA®oF-LL LOT #
System Installer: B ALL Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community tK Public ❑ Well Distance from well 100 feet
System Type: yR, tz ~ 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.
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
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t'Mil LUNUIITUNS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage field ditches H of each ditch Lb feet
French Drain Required: _ lan~ feet,
Alarm ❑
H2OLine ❑
PWR Line
Septic Tank: 100c) gallons Pump Tank: gallons
width of depth of
ditches feet ditches -3h2l- inches
Authorized State Agent vA 9f:-\N5 Date `1-317 0
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