OPH T E # 1-Q Harnett County Department of Public Health 23161
PERMIT # -l`-1� Operation Permit
New Installation Seto�iz:�is Tank Nitrification Line 1:1 Repair El Expansion
PROPERTY LOCATION. � L°� •
Name: (owner) O t;�X-,eC.- VtznE5 LLC, SUBDIVISION �s� o�► LOT # 5_
System Installer: Registration #
Basement with plumbing: ❑ Garage ', Number of Bedrooms L4
Type of Water Supply: ❑ Community "R. Public ❑ Well Distance from well l(Z)0 feet
System Type: '—)D 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.
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 ❑ Nox-I
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑
D -Box ❑
Pump ❑ Alarm ❑
112O1-ine ❑ PWR Line
Following are the specifications for the
❑ Conventional
sewage disposal s stem on he above captioned propperty.
Other 0 (YR 1 ca Qn 4ti^c�Q SL` Septic Tank: , DO 4
gallons Pump Tank: 100 0 gallons
Type of system:
Subsurface
Drainage Field
No. of
ditches
exact length width of
of each ditch '10 0 feet ditches
depth of
feet ditches inches
French Drain Required: Linear feet
Authorized State Ag 1
lerl Date ''/l r��
ent�= - -_