OPHTE# \1-~a2-16`b"1Q- Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 71 9
`'K New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LO(ATION: tatLlv175
Name: (owner) SUBDIVISION LOT #
System Installer: t>~C'oC.)k G Q~P'~~ a Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well 100 feet
System Type: o. Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact H alth Department 6 months prior to expiration for permit renewal.
90 4D
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage atment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
D
B B 1> Xt2.15 -
PERMIT CONDITIONS:
1. Performance:
System shall perform in accordance with Rule .1961.
If. Monitoring:
As required by Rule .1961.
111. Maintenance:
As required by Rule .19
61. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
t~1o F wr/ cry r Sere\1111 "'~4F- 4 40' f-VO5
❑
D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the spe
cifications for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional X Other Z- VI.-Ow Septic Tank: ► 00 O
gallons Pump Tank: gallons
Subsurface
No. of exact length width of
depth of
Drainage Field
13
ditches of each ditch '9 Q~ feet ditches
F
feet ditches ' inches
French Drain ReouiretL
`teems
4
Authorized State Agent V-~ " Date