OPHTE# J 1 -5 -,�ajl1i Harnett County Department of Public Health 23135
PERMIT # `� c Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansior
_ PROPERTY LOCATION: F-1 -` r�
Name: (owner) NA V4--L- SUBDIVISION LOT #
System Installer: Cam . Y�-s s i.-� Registration #
Basement with plumbing: El Garage El Number of Bedrooms Hot��c �cat� v 01 DES` zgar
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Q0 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
PLKMII LUNVIIIUNS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: LN Conventional ❑ Other
Subsurface No.�of exact length
Drainage Field ditches � of each ditch -2 5 feet
French Drain Reauired: _ _ ��tat
Alarm ❑ 1-12O1-ine ❑ PWR Line
Septic Tank: 1 ®O® gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent �c . \U \'`� �°` V- �5 Date t I �a-7
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PLKMII LUNVIIIUNS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: LN Conventional ❑ Other
Subsurface No.�of exact length
Drainage Field ditches � of each ditch -2 5 feet
French Drain Reauired: _ _ ��tat
Alarm ❑ 1-12O1-ine ❑ PWR Line
Septic Tank: 1 ®O® gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent �c . \U \'`� �°` V- �5 Date t I �a-7
13- �- 3a�g'�