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OPHTE# !( J"u`1 Harnett County Department of Public Health 24540 PERMIT # �� r�� t1 Operation Permit New Installation E( Septic TankNitrification Line El Repair El Expansion PROPERTY LOCATION: N �l`r j Name: (owner) R 0,Y(>' I- ©e��5 6 . GQ SUBDIVISION tkz[xZ'4 s 7 t a_LP of LOT # _ System Installer: 'DMrl.a, -3 M C-0�i1-3 Registration # Basement with plumbing: ❑ Garage Number of Bedrooms_ Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet System Type: =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. T KV11N 1 �" 35 �'\iD PERMIT CONDITIONS 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 ❑ N If yes, see attached sheet for additional operation ca IV. Operation: V. Other. maintenance and reporting. ❑ D -Box ❑ Pump ❑ Alarm ❑ 112O1-ine ❑ PWR Line Following are the specifications for the sewage disposal system 91 the above captioned property. Type of system: ❑ Conventional Other `- l—s_c v' Septic Tank It 060 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Fielddisc slt s of each ditch feet ditches feet ditches �a inches French Drain Required:_ _ �� Gnear feet Authorized State Agent \� - �� raj Date OR& Y t p. alt ,r'YO � i