OPHTE# 1 0sp®3 Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 31
New Installation `~j Septic Tank )9, Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1~ocsyEa. az>
Name: (owner) q~. V\Q) 1"4 C- SUBDIVISION Q~ s~MCre~ 11~1~s LOT # f-ii()
System Installer: TL y 5i2.sav t Registration #
Basement with plumbing: ❑ Garage `X Number of Bedrooms
Type of Water Supply: ❑ Community LAY Public ❑ Well Distance from well feet
System Type: 411 Types V and VI Systems expire in 5 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, Nules for Sewage Ireatment and Disposal, and all conditions of the Improvement Permit and lonstruction Authorization.
Ui 0 § 1GLn Uop
11 v
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
If. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ca oned property.
Type of system: ❑ ConventionalI Other C_NA P\tn5&,'L C.c Septic Tank: t® CO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch D S feet ditches 3 feet ditches OR 1-~ inches
French Drain Required: ar
Authorized State Agent Date C ,
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MT A
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1
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1 V
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3
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