OPHTE # 1 -S-9 5Harnett County Department of Public Health 24768
PERMIT # 9 15 4i Operation Permit
New Installation = Septic Tank ,X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 201 APp.Cx�C�a v 1 r
Name: (owner) Q (LC3cNs,1a K Guys &m N�LO m E. SUBDIVISION 6 v — Pe, sn l..' v LOT # a T
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _L
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ..ate c. 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:
I. Performance: System shall perform in accordance with
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes
If yes, see attached sheet for additional
IV. Operation:
Rule .1961.
maintenance and reporting.
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ 142O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abp/vea� captioned grope
Type of system: ❑ Conventional Other Ch$ a+t z Vl¢C .3G fl10 Septic Tank: 1 O o 0 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch Iso feet ditches 3 feet ditches N -;LO inches
French Drain Required. Linear feet
Authorized State Aeent %L -A2 Date
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