OPHTE# k5-•S=,55'i30 Harnett County Department of Public Health 23669
PERMIT # a'g3� Operation Permit
New Installation Septic Tank' Nitrifica ' n Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO : , t , o,*, Z
Name: (owner) SUBDIVISION LO'.
System Installer: Av ry,7" Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1c3(75 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 )ewage Ireatment ana ussposal, ana an conmmns or me
t
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation a
IV 0 f
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maintenance and reporting.
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pera Ion.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dispos8 system Whe above captioned property.
Type of system: ❑ Conventional Other N t1- e i 51h Septic Tank: 1®00 gallons Pump Tank: 46Q8 gallons
Subsurface No. of exact length width of depth of
Drainage Field "'fit es of each ditch Z�)6 feet ditches feet ditches tinches
French Drain Required: _ Linear feet
Authorized State Agent_____ \'� N � q5 Date
15- 5-`3 !3' 36