OPHTE# ��7`5-''1a3��► Harnett County Department of Public Health 25042
PERMIT # Operation Permit
New Installation "5�' Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: V a L arGo,� <na
Name: (owner) NiL- -,n1 4— C4�ssa vu;,i a SUBDIVISION LOT #
System Installer. N anfli,w 5e�r I f-- Registration #
Basement with plumbing: ❑ Garage '�K Number of Bedrooms y
Type of Water Supply: ❑ Commune � Public El Welt Distance from well feet
System Type: 7mti 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 hu been installed in compliance with appliable North Carolina General Statutes, Rules for Sewage Treatment and Dispaml, and all conditions of the Improvement permn and Consnu<non Aumonzahon.
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PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Fallowing are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E—Z FLO'.., Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch 6C5 feet ditches feet ditches T'8' L"t inches
French Drain Reouireds„� Linear feet
Authorized State Agent Ri'—(aA3 Date
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