OPHTE # 17-5' 15All's", Harnett County Department of Public Health 24743
PERMIT # 7 'N5+� Operation Permit
New Installation X Septic Tank X Nitrification line ❑ Repair ❑ Expansion
1 \` PROPERTY LOCATION: a�`1 VP"%FAX DaN,4f;
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Name: (owner) ` A --- V'VKt- rio cnG> Int L SUBDIVISION 9 t 4 Ga os3la 6 LOT # 11
System Installer: 0-ss,6 J'cQ;Nc*-uwD Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms i
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Net
System Type: tr) 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.
Ims system has been Installed in compliance with applinble North Carolina cement Statutes, Rules for Sewage treatment and Disposal, and ail conditions of the Improvement Permit and construction Authorization
rcann urnuwuns:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required.? Yes ❑ Ng,'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D•Box ❑ Pump ❑ Alarm ❑
H2O1-ine ❑
PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'St' Other E.Z. IFLil Septic Tank: i00a gallons Pump Tank: gallons
Subsurface No. ofexact length width of depth of
Drainage Field ditches i of each ditch 30 O feet ditches 3 feet ditches S$ inches
French Drain Required: � Linear feet
Authorized State Agent Date