OPHTE# -- aj6—gll� Harnett County Department of Public Health
23248
PERMIT # a �-%,i`�/ Operation Permit
New Installation Septic Tank ET' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /►'1 ��a���1� ��
Name: (owner) kQnfa1 /il l' SUBDIVISION //11."D-_,,4 LOT # _2
System Installer: Ac'"'k Grc�-4 - /L4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ,3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 5 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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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. 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 s disposal system on the above captioned property.
Type of system: El ewa Conventional Other 6_Z '/ L0 Septic Tank: /COO gallons Pump Tank: _
Subsurface No. of exact length width of depth of
Drainage Field ditches ! of each ditch JJ O feet ditches 3 feet ditches /Q_
French Drain Required: Linear feet
Authorized State Agen��� jgelf( Date r/ laxly
PWR Line
gallons
inches
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