OP4TE# Harnett County Department of Public Health
PERMIT # Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Cmy--=—j L.., VQ—
Name: (owner) m e,5 Ll-- C. SUBDIVISION 0 NY—no r K LOT #
System Installer: Z-�o-go G. GA2v-4 C-4- Registration #
Basement with plumbing: ❑ GarageIt I -
Number of Bedrooms
Type of Water Supply: ❑ Communi Public El Well Distance from well t c� ® 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.
Ims 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
it I r 1
Ha 056— f
t �
1
V
I
{
wH`is'V L Q6+
PtKMII LUNUIIIUNS:
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 ❑ NoV
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above �a�tionedoperty.
Type of system:
El X Other �N�c�BE2- — Septic Tank: l (Sod gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch 9-00 feet ditches feet ditches tig' inches
French Drain Reouired` 1%tz,� Linear feet
Authorized State Agent — ---Ib __'__ _ Date
is - 5- 3 41M