OPHTE#I —S 3CAtl Harnett County Department of Public Health 23766
PERMIT # ansa Operation Permit
X, New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOICATION: P.assert Pa Rch v
Name: (owner) (Np
(NL —SUBDIVISION T,7)%AQ% t Gz.0551rv6 LOT # a3
System Installer: C}Ns,s rJ ;qxc, rxa ro Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms_
Type of Water Supply: ❑ Community JK Public ❑ Well Distance from well Ib0 feet
System Type: b 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 Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
�01 TF-1
NDusE
D
Q
�AKtrPx D2,
rcnrni sununiuns:
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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•Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the above captioned 'property.
Type of system: [I Conventional � Other 6U'MP 6 E2 (i'LC1M1 Septic Tank: 1800 gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage Field Itc ". _. of each ditch O feet ditches 3 feet ditches S� inches
French Drain Reauirelh\ � Linear feet
Authorized State Agent 'V4"\ tTlS Date 101 IS)1S
r
,� ��'r g t f �.
x
�E�