OPHTE#1� —� Harnett County Department of Public Health 24555
PERMIT # ��l x"13'1 Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 2A�EN Qpc- 6 0
Name: (owner) K�, E>`t CQ "CN mI AQ5 SUBDIVISION LOT #
System Installer: OmNs 'E37R,Registration #
Basement with plumbing: ❑ Garage Ls Number of Bedrooms
Type of Water Supply: ❑ Community, Public ❑ Well Distance from well feet
System Type: —=t., 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 Treabmnt and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ 1101"<
If yes, see attached sheet for additional operation ct
IV. Operation:
maintenance and reporting.
V. Other. S67r. s 'C-)Ataiw &6z SisVC: l r, i -46. -4N -Y ocb� 10N
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on she above captioned property.
Type of system: ❑ Conventional � Other E L �l. eW Septic Tank: MOO 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 300 feet ditches 3 feet ditches iii"y� inches
French Drain Re vire . Dnear feet
Authorized State Agent — 4N5 Date 513 T`)—)
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ 1101"<
If yes, see attached sheet for additional operation ct
IV. Operation:
maintenance and reporting.
V. Other. S67r. s 'C-)Ataiw &6z SisVC: l r, i -46. -4N -Y ocb� 10N
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on she above captioned property.
Type of system: ❑ Conventional � Other E L �l. eW Septic Tank: MOO 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 300 feet ditches 3 feet ditches iii"y� inches
French Drain Re vire . Dnear feet
Authorized State Agent — 4N5 Date 513 T`)—)
T