OPHTE# lid S -3q Harnett County Department of Public Health 24610
PERMIT # Q01 04 Operation Permit
New Installation Septic Tank Nitrification Line 1:1Repair ❑ Expansion
PROPERTY LOCATION:`TNcev4 1�0
Name: (owner) iso. +��LQvstAD2t5 a SUBDIVISION TQ:5 Pot;zES LOT # 136
System Installer: Eryp.�cat_ 5vtt_oE4a Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: =C' 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.
Thus stem has been imtalled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all rondidons of the Improvement Permit and (omtrunion Authomadon.
I
�e
P I(
A A
zIt
I
A l
ov&C
r
PERMIT CONDRIONS
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Bax ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional �< Other E Z Ft -OW Septic Tank: 100 8 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Lst of each ditch C feet ditches 3 feet ditches I$ -ail inches
French Drain Required: _:::�Z_ Linear feet
Authorized State Agent F"w Date 78
i � - 5-3`��as
��.. •,.l 1,,
�. ,:z+.,
,.
1g ;r; ,
,_ .#
a f � r,
•_
�s _ _- -�- `' � - -