OPHTE# I ll 5 -sc►az� Harnett County Department of Public Health 24566
PERMIT # WN 04 Operation Permit
New Installation �K Septic Tank Nitrification Line ElRepair ElExpansion
A PROPERTY LOCATIONea 46— N
Name: (owner) '16 o o � D aj vs.� `A 4 SUBDIVISION V>rN-iONs Qo\ 4T LOT # 135
System Installer. S,,� tar, c N _ P.v» 06¢ S Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms r'1
Type of Water Supply: ❑ Community Public ❑ Well Distance from well MO feet
System Type: _�= P, 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 Nord 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
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 u
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional N Other 6-_ rS-0 w Septic Tank: 100 0 gallons Pump Tank gallons
Subsurfa No. of exact length width of depth of
�3 0 feet ditches 3 feet ditches f inches
Drainage Field itch of each ditch _
French Drain Rea Linear feet
Authorized State Agent �w �� Date