OPHTE# O°1-51StiS Harnett County Department of Public Health 2 0 g 1 7
PERMIT # 3~ Operation Permit
I New Installation ~R Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: QZ
Name: (owner) SUBDIVISION As,Fda~ LOT # 5`~L,
System Installer: its 5sa,~ i a.TAP Registration #
Basement with plumbing: ❑ Garage \,8( Number of Bedrooms 3
Type of Water Supply: El Community Public ❑ Well Distance from well 1 00 feet
System Type: to 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.
...u >ruem nas ueen mstaoea in
with applicable North Carolina General Statutes Rules for Sewage Treatment and Disposal, and all conditions of the
Permit and fonstruction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No X
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: S yeM G+ccxr~ i,t O7\ . Wa<6t2, L awl, s.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other G--L Septic Tank: t00d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch F' feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ~ X !-Ef
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