OPHTE# 13 - 5-3 1-1-1 t Harnett County Department of Public Health 23066
PERMIT # �-��s�i Operation Permit
New Installation 'Z�q Septic Tank 'K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: MaQy, Q.1b
Name: (owner) umaFn.LA tlon+E ,mac. SUBDIVISION Wngo LOT # _
System Installer: Std acio,rc N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms H
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Sb0 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
rcnrul LvNuiiluns:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No)'Zv
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal,. system on the above captioned perty.
Type of system: ❑ Conventional Other C'vi ;!��" ("�i�-1 — Septic Tank: SO® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1-5-0 feet ditches 3 feet ditches 3C " W inches
French Drain Reauired� —�. Lini?,feet
Authorized State Agent 1 ' v Date 1
t3- 5- 3 y- m