OPHTE# 11 -5 g116 Harnett County Department of Public Health 24757
PERMIT # 9.1) 511!) Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: F•o L - LY 0T
Name: (owner) V Saco iii i N c SUBDIVISION S� ees�t,Pa LOT # 5St-_
System Installer: =a -Il s SER•SsC, SUL-4icG Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: h 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 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.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operaIon conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disp al system on the above ca boned grape
Type of system:
EJ A Other s +agEA -Q .- 6 ��i0 J Septic Tank: 1601 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field - ditches i of each ditch 1'�8'0 feet ditches feet ditches 30-3C inches
French Drain Required: �- Linear feet
Authorized State Agent_ `%\\\\ (�-G*4 s Date
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