OPHTE# 11 ° 5 -��t ia. Harnett County Department of Public Health 23290
PERMIT # Operation Permit
XNew Installation �N( Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: U fn M % N C
Name: (owner) oe M y SUBDIVISION LOT # I
System Installer: j -is C�'°, ci—N c;�f_L KNP Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public k Well Distance from well t ®4 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 Disposals and all conditions of the Improvement Permit and Construction Authorization
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 ❑ PWR Line
Following are the specifications for the sewage disposal system ori„the above captioned property.
Type of system: ❑ Conventional Other 4:.. -c__ 'k' �.tw�/ Septic Tank: t 5 b 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditccFe_s ° _ of each ditch feet ditches 3 feet ditches �� "��$ inches
French Drain Required: s . "-_ r feet
Authorized State APent ZI�NN�11 Q6�4X5 Date S I �:T't