OPHTE# 1-1'5-W1Harnett County Department of Public Health 25105
PERMIT # ¢97 Operation Permit u
New Installation I Septic Tank -L�l Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -O,) v %ft QP
Name: (owner) HVo-LI CaLc.uT SUBDIVISION LOT #
System Installer. �6te Srt0ev+1%5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: G Types V and A Systems expire in S years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
[his 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 Authorization
/ R
f 7 /
Pa ! A r
� e
NdvaE
O
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation a
IV. Operation:
V. Other.
maintenance and reporting.
❑ —D -Box LlPump ElAlarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal ys stem on the above captioned property.
Type of system: ❑ Conventional � Other EZ Fta W Septic Tank: \ 00 a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field & hes, Lac of each ditch 0 feet ditches 3 feet ditches 111-aO inches
French Drain Required: Linear feet
Authorized State Agent Date