OPHTE# Q-5-Li1 7" Harnett County Department of Public Health 24903
PERMIT Operation Permit
New Installation -72, Sep tic Tank 'N� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOICATION: t5Ua(bGL W745aN oc1-
Name: (owner) M oar t of=o to 'is So+.l SUBDIVISION LOT #
System Installer: L-,:.2 Su�w( Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ]Two Types V and A Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ibis 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 ConSndiDn Authorization.
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PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑
D•Box ❑
Pump ❑ Alarm ❑
M20Line ❑ PWR Line
Following are the specifications for the sewage disposal s
stem on the above captioned property.
Type of system: El
Conventional Other F -Z
Gt-0h4 Septic Tank: i000
gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
dill s "41
exact length width of
of each ditch feet feet ditches 3
depth of
feet ditches V -a24 inches
French Drain Required:
_
linear
feet
Authorized State Agent —"azz" ltd J)z�� Date
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