OPHTE# �6'S.64 Harnett County Department of Public Health 23762
PERMIT #a�'33tit Operation Permit
New Installation 7X Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Z- Q--
Name: (owner) V\ P%" Vat—"TQ 3 SUBDIVISION SoHm5o LOT # 1 P.
System Installer: $Q*V'0 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community )< Public ❑ Well Distance from well t OO feet
System Type: a. Types V and VI Systems expire in S 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 appliable North Carolina Geneml Natures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement NMI( and lnnsuucnnn Autnonzanon.
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PERMIT CONDITIONS
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal lssystem on the abovea [lone roperty.
Type of system: El Conventional X Other I�HAMQt'-1L S�1_ Septic Tank: Ib00 gallons Pump Tank: gallons
Subsurface _1To.�of. exact length width of depth of
Drainage Field ditches of each ditch 110 feet ditches � feet ditches a.y ^3 ` inches
French Drain ReauiredA\ r feet
Authorized State Agent 014) Date
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