OPHTE# 1-1 —5—LA \ 9`1-5 Harnett County Department of Public Health 25028
PERMIT # `QL`1(e`1 Operation Permit
New Installation �N Septic Tank X Nitrification line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: iiia -1 t4
Name: (owner) J cz,"y"S H o,.t 1 w-1 La CL SUBDIVISION —\ YLA—L LOT # 10
System Installer: CA<lay G a "94ct;\ Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 5
Type of Water Supply: ❑ Community iK Public El Well Distance from well feet
System Type: �e 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 far Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PLKMII CUNUIIIUN):
1. 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 ElNoe
If yes, see attached sheet for additional operation ca
IV. Operation:
V. Other
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2O1-ine ❑
Following are the specifications for the sewage disposal system on the above captioned to try.
Type of system: ❑ Conventional Other CNNK,%60- �kry—U. Ai•S0� Septic Tank: s O gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches s of each ditch 3OO feet ditches 3 feet ditches t1'3o
French Drain Required: Linear feet
Authorized State Agent H Date ]1-?
PWR Line
gallons
inches
I -1- 5- 2� � 5lS
A