OPHTE# J�'= �= -:7C-Harnett County Department of Public Health 23701
PERMIT # �,'� 05Operation Permit
L I New Installation 2" Septic Tank 2" -Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:—
Name: (owner) A SUBDIVISION LOT #
System Installer: sE-�Q— A4,4; (e � Alcve.� Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _5—
Type
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: -I- 4 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.
nns system nas ueen ms(anea in compuance wan appucame north carouna beneral Statutes, Rules for Sewage Ireatment and
and all conditions of the Improvement Permit and construction Authorization.
rs:nrut svivunlvlr�:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 systemon �the a ove captioned property.
Elsau
Type of system: Conventional Z Other c `f Ncwn.�_t— Septic Tank: /-�S--O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 600 feet ditches feet ditches /8 inches
French Drain Required: Linear feet
Authorized State Agez Z �LiLlw— Date 71 2 °� s'
/5=r= 3 c,7 2�