OPHIE #l --)'S 44!y* "V Harnett County Department of Public Health 24591
PERMIT # ��SS Operation Permit
New Installation )5( Septic Tank �< pNitrification Line 11 Repair 13 Expansion
�^ PROPERTY LOCATION: Gc� 1665 'W
Name: (owner) VAti �a3�l�iso�r ib SUBDIVISION $t irr.6 V—tT2 LOT # N1
System Installer.Fo�,E WZ4 CL Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: =11 c 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.
Inn system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Comtrudon Authorintion.
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa a disposal system on the above;allponedp perty.
Type of sys Conventional Other &i,sJCN^ 62 W -'N � Septic Tank 00 G gallons Pump Tank gallons
Subsurface exact length width of depth of
Drainage Field dit of each ditch 110 feet ditches 3 feet ditches Qy inches
French Drain Require . Linear feet
Authorized State Agent_ \ �� :� g';: JS Date