OP RHTE# I (o-5Harnett County Department of Public Health 24550
PERMIT # Operation Permit
New Installation Se(p�tic Tank Nitrification Line 11 Repair ❑ Expansion
PROPERTY LOCATION: VFS1 i-Ah\D1h16
Name: (owner) L, 'i O N 96 Q»0 G?.s 1N L SUBDIVISION GAsLo t_\ N P LJ;N-cL> LOT # G ci
System Installer: Lc�,q.ay S, ,p tu2 I:, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well feet
System Type: \ 1 \ 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.
Ines system no been imtalled in compliance with applicable North Carolina General Smmtes, Rules for Sewage Treatmem and Disposal, and all conditions of the Impmvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: At required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: El Conventional Other 7_ GLevr Septic Tank: LO Da gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field dltc 1 of each ditch ^j1.5 feet ditches 3 feet ditchesinches
French Drain Required _ �_ _ r feet
Authorized State Agent Date