OPHTE# t1 S-Harnett County Department of Public Health
PERMIT # ~6~`i3a Operation Permit 2 2 41 7
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Sao c 5 Q-s>
Name: (owner) '1A'$,A,,r N°s ~t-t t @ SUBDIVISION 12c 5 TLOT # BS
System Installer: .o~;~~~ ~t_ym~`rsC Registration #
Basement with plumbing: ❑ Garage , Number of Bedrooms +
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 b O feet
System Type: a _ 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.
Ihis 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
I' Mil CUNUIIIUNS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
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 captioned property.
Type of system: ❑ Conventional Other E-Z Vow Septic Tank: 14®~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ each ditch C~ feet ditches feet ditches inches
French Drain Required: - fee
Authorized State Agent Qr Date -113 111