OPHTE# 17--5-'M_7S7 Harnett County Department of Public Health 25034
PERMIT # a"'TO \ Operation Permit
New Installation 'V Septic Tank '�D< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Nils_ \, so npJ P�
Name: (owner) Flo N Pc�mKt4 ) (Al i -a SUBDIVISION LOT #
System Installer. y 61 Lp w Oo c Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms t'}
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: SiZc� 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.
Imo system has been installed in compliance with applinhle North Carolina General Stamtex Rules for Sewage Treatment and Disposal, and all mndmons of the Improvement Pemit and Construction Authoriaation.
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1. Performance: System shall perform in accordance with Rule .1961.
ll. 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 ❑
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H2OLine ❑
PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: El Conventional >� Other E�.ow Septic Tank: 1660 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc es of each ditch 306 feet ditches 3 feet ditches inches
French Drain Required: ' eacfeet
Authorized State Agent V Date _5
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