OPHTE #J 5,_5 Harnett County Department of Public Health 2 3 6 4
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PERMIT # Operation Permit
New Installation :K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: CaQC'Ety Ut'-Z' "
Name: (owner) u , 0�.2`� ri cP SUBDIVISION ' f_! S -C Cie vv C- Sv m m-T� LOT # 1�
System Installer: Ulop--r_- C= 1rvLr Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms S
Type of Water Supply: ❑ Community Public ❑ Well Distance from well DC7 feet
System Type: 1 } :L c_ 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.
nils system nas peen mstanea In compliance Wan appucame NOrtn laronna t3enerai matutes, awes for )ewage treatment anoyisposal, ano an Conditions of the Improvement Permit and Lonstructlon Authorization.
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I'M11 LUNDIIIUNS:
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 ❑
Following are the specifications for the sewage disposal system on the above a,�t^ion property.
Type of system: ❑ Conventional "1 Other C.,aAa� ( j' Septic Tank:
Subsurface No. of exact length width of
Drainage Field--'ttitel of each ditch 1 Cl b feet ditches 3
French Drain Reouired:,a, Linear feet
Authorized State Agent__ v` v \\ 5 Date `'
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches t inches