OPHTE# 1 14Z0 Harnett County Department of Public Health 24902
PERMIT # a" 5-3 S Operation Permit
New Installaticl Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: B2ij Cjgg_b _; C" uszOi qN
Name: (owner) as 'S�y R. B AN w SUBDIVISION LOT #
System Installer. t--ft-s4q Swo.29C Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community �K Public ❑ Well Distance from well feet
System Type: =e, 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 fathoneation
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
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 Ys �tem on the above captioned property.
Type of system: El Conventional IR Other GZ 57L -0w Septic Tank: i OD d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field es 1 of each ditch 300 feet ditches 3 feet ditches inches
French Drain Reouired Linear feet
Authorized State Agent s\\ 2C --1z 5 _ Date a
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