OPHTE# C)-) S" ►$O~-~ Harnett County Department of Public Health 21 4 2 9
PERMIT # 'W-~ )`'1 I Operation Permit
New Installation 1, Septic Tank ❑ Repair)4 Nitrification Line ❑ Expansion
PROPERTY LOCATION: Sttowty ~-c~
Name: (owner) R) 9,o d C). Q „,;tA SUBDIVISION i?-;IN E-„ sgaon~~ LOT # 3
System Installer: N1 L Pzj Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1(00 feet
System Type: 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.
um system nas peen mstanea in compuance with applicable north larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: A Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches 1 of each ditch feet
French Drain Required: Linear feet
Septic Tank: 1040 gallons Pump Tank: _
width of depth of
ditches 3 feet ditches
gallons
inches
Authorized State Agent s Date I31 ld