OPHTE# 1-1"5-4 tFCL1). Harnett County Department of Public Health 24749
PERMIT # a,"Sa� Operation Permit
New Installation % Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: X005 fico
Name: (owner) "s—ws SUBDIVISION 00%e -m6 tr. LOT #
System Installer: Gwct.aby SEf'58Cr Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: —imp 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.
This 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 Construction Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? yes ❑ Max
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 sewage disposal system on the jI Love captioned�pproperty. 11
Type of system: ❑ Conventional Other Ptl+++P�o LYutac p�L_l9 134104 Septic Tank G gallons Pump Tank F D O d gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch 150 feet ditches 3 feet ditches 1E2 30 inches
French Drain Required: Linear feet
Authorized State Aeent l��� `Z_C»S Date
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