OPHTE# 1(._5- 46a%-6 Harnett County Department of Public Health 24549
PERMIT # Operation Permit
XNew Installation Se tic Tank X Nitrification Line ❑ Repair L1 Expansion
PROPERTY LOCATION: Se
Go ov6 (�A
Name: (owner) LOT #
System Installer: e a Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 7 —)1e 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 Stations, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
r�
r �
r �
KEPAs2 �`
.\J
36
cep
t—
He✓.iL-
P
c
Bias G2oVE Z.P
YtRnll LUDDIIIUM:
I. 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 ❑
Alarm ❑ H2O1-ine ❑ PWR Line
Following are the
specifications for
the sewage disposalllss'stem on the above captioned property.
Type of system:
El Conventional
Other C'2. F&& W
Septic Tank: 100 O gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
3
Drainage Field
ditches
of each ditch feet
ditches feet ditches inches
French Drain Requi : Linear feet
Authorized StateAgent < % Date, l7