OPHTE# 3-S-1�b3% Harnett County Department of Public Health 23763
PERMIT #a—)�O� Operation Permit
X New Installation �K Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
�^ PROPERTY LOCATION: Docs
Name: (owner) Yrc"�.x7N(S�ZtLV SUBDIVISION =rLa-n a -S R,,0wa LOT # 6b
System Installer: �i-�o<Tv„15 t5a..%la`f1avNG Registration #
Basement with plumbing: ❑ Garage :K Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: a 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.
[his system has been installed in compliance with applicable North Carolina General statutex_Rules for Sewage Treatment and Disposal, and all conditions of (he Improvement Permit and construction Authoritarian
rcmvr t.unu[[[vm:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required Yes ❑ N
If yes, see attached sheet for additional operation co
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s tem on [he above captioned property.
Type of system: El Conventional 'K Other �s..� Septic Tank: S OO C) gallons Pump Tank: gallons
Subsurface exact length width of depth of '�,'�L
Drainage Field ditches of each ditch S feet ditches 3 feet ditches I inches
French Drain Required:\ \ _ Linear feet
Authorized State Agent Q64+----3 Date
1 ,
>71
f
i
� NO vsE
Y
2
4
G
Goma (::-,)I C5
rcmvr t.unu[[[vm:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required Yes ❑ N
If yes, see attached sheet for additional operation co
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s tem on [he above captioned property.
Type of system: El Conventional 'K Other �s..� Septic Tank: S OO C) gallons Pump Tank: gallons
Subsurface exact length width of depth of '�,'�L
Drainage Field ditches of each ditch S feet ditches 3 feet ditches I inches
French Drain Required:\ \ _ Linear feet
Authorized State Agent Q64+----3 Date
J
17
8ri
lopp-A!
1-1 S