OPNTE# t -7-s-4169 Harnett County Department of Public Health 24737
PERMIT # a°�6�1 Operation Permit
New Installation �'K Septic Tank Nitrification line ❑ Repair ❑ Expansion
t� PROPERTY LKATION: Wsa_L. Lvaw+ Qa
Name: (owner) F'csL oassC,C-0 )N c- SUBDIVISION LOT # a�T
System InstalleRegistration #
Basement with plumbing: ❑ Garage)< Number of Bedrooms L4
Type of Water Supply: ❑ Commun�jgl Public ❑ Well Distance from well feet
System Type: 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 North Carolina General Statutes, Rules for Sew Treatment and Disposal, and all conditions of the Improvement Permit and tunffiucuon aumonaauon.
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PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑No
If yes, see attached sheet for additional operation a
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other E-7, Fa:.7-W Septic Tank: 100 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches GC7 inches
french Drain Required: -Nar feet
Authorized State Agent Qf-.�A5 Date