OPHTE# \ \-S_a (-Q- c1 Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 21 8
1 New Installation `I~ Septic Tank Xj Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Po~~~osa CZ~
Name: (owner) ~6125-5 u~1-s 0-2-42 V SUBDIVISION ~AZC,t-~~a~ 56t~so~ss LOT #
System Installer: Q-TN,5 Registration #
Basement with plumbing: ❑ Garage '5< Number of Bedrooms 1
Type of Water Supply: ❑ Community '~K Public ❑ Well Distance from well Ito feet
System Type: =Ll 0 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, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. 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 ❑ No
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 ctioned property.
Type of system: ❑ Conventional Other ymP7'a &1- t..Q r Septic Tank: LOW gallons Pump Tank: 1000 gallons
Subsurface of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches %10 " 3 ® inches
French Drain Required:
Authorized State pent 9.GM5 Date
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