OPNTE# l ,-53Atto7 Harnett County Department of Public Health 24538
PERMIT # L-A 40 Operation Permit
New Installation `A Septic TankNitriication Line El Repair El Expansion
^ PROPERTY LOCATION: Qo.rE
Name: (owner)SUBDIVISION — LOT # 1
System Installer. 1 iAw> J .{ PC1L Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms 3
Type of Water Supply: ❑ Community-2XIPublic ❑ Well Distance from well feet
System TYPe: T rn 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 Noah Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NuX
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 xo�n-t�he above captioned property.
Type of system: Li Conventional A Other E Z r1 m ✓ Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field3 3 of each ditch a feet ditches feet ditches �� inches
French Dain Required Linear feet
Authorized State Agent :N"� Date
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