OPHTE# I1-6-41YI3 Harnett County Department of Public Health 24162
PERMIT # Operation Permit
ew Installation Septic Tank-p'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N3_� Pond Un. (GIn.S;l sc k.ct.I, WL, I V,
Name: (owner) wy no Q:)gn(ru 4'On ='c. SUBDIVISION u pot�= LOT #
System Installer:— Registration #
Basement with plumbing: ❑ Garage G7r1 uEmber Bedrooms
Type of Water Supply: ❑Community �❑ Well Distance from well rV feet
System Type: _ � flo��r it-'Alcn �>3 7� 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 has Mtn 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.
II. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage di mal system on the above captioned ro
Type of system: ❑ Conventional Z!%ther c� 1l rN..5 Septic Tank: 12160 gallons Pump Tank: VdI56 gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch 1'3 S feet ditches 3 feet ditches JG—e_6 inches
French Drain Required: Linear feet
Authorized State Agent �����.i�!/15 Date
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