OPHTE# la - s- 411 Harnett County Department of Public Health 241 5S
PERMIT # a 55S Operation Permit
Cwt ew Installation ❑eptis TankI rC�N it I on Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I;i a 3 s , c, W Ot ,,.% na (— 'SA L9 Qag )
Name: (owner) SUBDIVISION LOT #
System Installer. "Registration #
Basement with plumbing: ElGarage � umber Bedrooms _3
Type of Water Supply: ❑ Communiry L blic ❑ Well Distance from well 4 feet
System Type: 'a —— Types V and VI Systems expire in S years.
(In accordance with Table V a) 0 r 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 rhe Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance:
11. Monitoring:
Ill. 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 I'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal sys m on the above captioned property.
Type of system: El Conventional 11 Other ('G 3Ce �—�mlrf Septic Tank: Aczic gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches a of each ditch feet ditches 3 feet ditches 3y inches
trench Uram Required: Linear feet
Authorized State Agent Date