OPHTE# 1 7-5�O�o 1 Harnett County Department of Public Health 24918
PERMIT # a-`\�r1 Operation Permit
New Installation � Septic Tank Nitrification Line El Repair E) Expansion
PROPERTY LOCATION: Suss Ocz.
Name: (owner) s U I\..p\ro C SUBDIVISION 'T, va66r.1 Fcsvo , f— LOT # 173
System Installer: E Gco'INt5i. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms t ,
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
'N
QPM ,
1
1.1 ous 6
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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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Boz
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the sewage disposal system W_ he above captioned property.
Type of system:
El Conventional
'14 Other Pv —& ) G Septic Tank: 1000
gallons Pump Tank: 113 0 0 gallons
Subsurface
No. ofexact
length width of
depth of
Drainage Field
ditche
of each ditch SSO feet ditches 3
feet ditches '�� inches
French Drain Remitted:
feet
Authorized State Agent eL+s Date ::01.7)16