OPHTE# Harnett County Department of Public Health 23664
PERMIT # Operation Permit
,X New Installation �K Septic Tank, Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: U54- ,7
Name: (owner) Cr-;&v5°T��K-,66.6 La SUBDIVISIONc:�-Y L c,s2 JOT #
System Installer: ,. Registration #
Basement with plumbing: ❑ Garage ,' Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I epQ feet
System Type: � t» 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.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NDA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other
Subsurface f exact length
Drainage Field ditches of each ditch � feet
French Drain Required: \ inear feet
H2OLine ❑
PWR Line
Septic Tank: 1500 gallons Pump Tank: gallons
width of depth of
ditches feet ditches 1 inches
Authorized State Agent � Date