OPHTE# 11-5'41,44C Harnett County Department of Public Health 24909
PERMIT # a 1� T 3 Operation Permit
New Installation �K Sep tic Tank A Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: tpuss On -..t6
Name: (owner) �. `, sC -Lr—o Co ccao scans lH SUBDIVISION 1iioo6v4 Lpsve,5 LOT # @\5A
System Installer. --kfl bout. r A Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms 5
Type of Water Supply: ❑ Communl X Public ❑ Well Distance from well feet
System Type: _ .1.11!h Types V and VI Systems expire in S years.
(In accordance with Table V� 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 Rule .1961.
ll. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box
❑ Pump ❑ Alarm ❑
11201-ine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the aboyy� property.
Type of system: El
_ccaptio
Other CHwM n 1 � Septic Tank: tZco
gallons Pump Tank: gallons
Subsurface
No, of
exact length width of
depth of
Drainage Field
ditches
of each ditch 300 feet ditches 3
feet ditches_ inches
French Drain Required:
et
Authorized State Agent wy bias Date
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