OPHTE# 1-7-5-4 40 Harnett County Department of Public Health 25083
PERMIT # a�1`aib Operation Permit
New Installation LX Septic Tank �*'K Nitrification Line ❑ Repair ❑ Expansior
,(� PROPERTY LOCATION: L4%1 PoNt�Aiesa Q�
Name: (owner) \1000NLNn� Y`yTN9AA L'Sc o -n SUBDIVISION LOT #
System Installer. 'J Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Common Public ❑ Well Distance from well feet
System Type: !J) 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 for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authomation
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation c1.
IV. Operation:
V. Other:
maintenance and reporting.
❑ —D -Box ❑ Pump ❑ Alarm ElH2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned prope
Type of system: El Conventional Other CwP maga. Cfa�a.c,34 1110 Septic Tank: 1.000 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches 3 of each ditch 6 feet ditches 3 feet ditches inches
french Drain Required: Linear feet
Authorized State Agent 1 Date
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