OPHTE# 17 -5-dj )"a,6 Harnett County Department of Public Health 24896
PERMIT # a°1(,Y-) Operation Permit
New Installation 'E� Septic Tank IN Nitrification Line ❑ Repair ❑ Expansion
l PROPERTY LOCATION: Oa.c) yp51121
Name: (owner) ��-�P-XoCLSn
� L ksr yRQ UR Jt�Q of SUBDIVISION Ynaa.r,Nt_ DG].R.,'RNoCE LOT #
System Installer: I IAOY
o"!; V LI) Gq� rA ` Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms L_
Type of Water Supply: ElCommunity '7X Public ❑ Well Distance from well feet
System Type: ZS1 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
PERMIT CONDITIONS
I. Performance:
IL Monitoring:
III. Maintenance:
IV. Operation:
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
following are the specifications for the sewage disposal system on the above motioned property.
Type of system: ❑ Conventional Other Pvm#'So EZ_ Septic Tank: 1 O O a gallons Pump Tank gallons
Subsurface No, of exact length width of depth of
Drainage Field edit t of each ditch feet ditches 3 feet ditches 19-a4A inches
French Drain Required: Linear feet
Authorized State Agent fa -Y16 Date
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