OPHTE# )%�S—Zll°��� Harnett County Department of Public Health 24886
PERMIT # h� Operation Permit
New Installation 1�1 Se tic Tank 'X Nitrification Line El Repair El Expansion
PROPERTY LOCATION: DppOXVsEW GS.
Name: (owner) SUBDIVISION Ha Cz4r—Y= LOT #
System Installer: G44 Registration #
Basement with plumbing: ❑ Garage V Number of BedroomsM
Type of Water Supply: ❑ Com�muni ' Public ❑ Well Distance from well feet
System Type: "HILTypes 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 synem has been imulled in compliance with applicable North Carolina General Statutes, Rules for Sewa Treatment and Disposal, and all conditions of the Improvement Permit and Comwclion Authoruawn.
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PERMIT CONDITIONS
1. Performance:
H. Monitoring:
III. Maintenance:
IV. Operation:
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 conditions, maintenance and reporting.
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above aptioned 7p8perty.
Type of system: ❑ Conventional X Other Qu �e i° Qn c 3b ii lU Septic Tank S�
Subsurface No. of exact length width of
Drainage Field ditches of each ditch S6C) feet ditches
French Drain Required: ® linear feet
H2OLine ❑ PWR Line
gallons Pump Tank: I 0 gallons
depth of
feet ditches S� inches
Authorized State Agent ���� Date