OPHTE# *1 35� c �y Harnett County Department of Public Health 23654
PERMIT # 31® Operation Permit
�1 New Installation Septic Tank '>< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 1-4 SUBDIVISION iIn, L Svtwnrl,TLOT # �a•�
System Installer: s t �CUX_ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well L CDO 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 rernt and Lonstructson HutnoriMIun.
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional x' Other r 'Z � Ooo Septic Tank: 1 DOD gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch 1.50 feet ditches feet ditches2 (�—QLD_ inches
French Drain Required: +i¢gar feet
Authorized State
Date G