OPHTE# 19--5431S� Harnett County Department of Public Health 25025
PERMIT # Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: i'o +oErt asQ 1?0
Name: (owner) Qsr_-I_y M(Wt�ol SUBDIVISION LOT # a'5
System Installer. L -.noxi f>A^ (- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: _ - 1 :g' 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.
IMS system hu been msulled in compliance with applicable North Carolina General Sumter, Rules for Sewage Treatment and Disposal, and all condifions of the Improvement Permit and (onsnuction Autl omnon.
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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 -Boz ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 'i1Q.E.. GA \V S Septic Tank: 1 00 Pr gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditd 1 of each ditch X640 feet ditches 3 feet ditches 12? S Ci inches
French Drain Required Linear feet
Authorized State Agent PkA5 Date
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