OP RRHTE# 1%-5'y4 Harnett County Department of Public Health 25040
PERMIT # a`�16 Operation Permit
New Installation )KI Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: OLe, 0',411
Name: (owner) ". D QorzxN SUBDIVISION MAS Nt& Q otsG LOT # c'�
System Installer: __7� oct,-r amsr�� wmc� •� s 7Registration #
Basement with plumbing: ❑ Garage r5 Number of Bedrooms -
Type of Water Supply: ❑ Community 'X 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.
lots system has been installed in Compliance with appliahle North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Awhonunon
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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 ❑ Noq
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Bax ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal sTstem on the above captioned property.
Type of system: ❑ Conventional �I Other 1=Z VLo r. Septic Tank: se(Z>O gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field di t of each ditch ),5S_ feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Alzent � Date