OPHTE# �� —��� Harnett County Department of Public Health 23153
PERMIT # a-�ci�t Operation Permit
New Installation `ICJ Septic Tank 4 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Coeq�_ , L_
Name: (owner) Zj :' (i�_>\j%L_QER'5 IN c, SUBDIVISION WG �,�(�1sJC �N� Suss;, LOT #
System Installer: Ec,)w a- Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms H
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well 10) O 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
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PERMIT CONDITIONS:
I. 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal system on the abo capti property.
Type of system: El Conventional X Other- ���SC�1 �K Septic Tank: gallons Pump Tank:
Subsurface _ No. of exact length width of depth of
Drainage Field ditches of each ditch 15-0 feet ditches ® feet ditches aLi-3 C
French Drain Required:
Authorized State Agent �'� \ `'� ° \�'�•,>�5 Date 31 "11
PWR Line
gallons
inches
�3 5- I� o-) 3