OPHTE# #-1 Harnett County Department of Public Health 23122
PERMIT # an'r- 1) OlDeration Permit
New Installation Sep Tank Nitrification line 1:1 Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) -j n 0 WL AMA �M45 1Na SUBDIVISION N'5',1 LOT # 'S 24
System Installer: t Lc> GQ,1u-,0N Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms L4
Type of Water Supply: ❑ Community 1K, Public ❑ Well Distance from well 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.
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
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No)K
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other: SS F- S uBD) -► sS10t4 V) Ps q 'FQn - Z-xD.cx F.AS(,rn6, ,N 1--w-,,W
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned propeerrty.
Type of system: ❑ Conventional X Other 9 UM9 `S ®,ACrQ- Septic Tank: 10o0 gallons Pump Tank: l006 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 30 G feet ditches 3 feet ditches I'i-)J -) inches
French Drain Reauired: feet
Authorized State pent _ � ���� yzY .S Date 114).61)3
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