OP RRNTE# 15-5-35L-69 Harnett County Department of Public Health 23832
PERMIT At 'a 3a' Operation Permit
)fir New Installation '�K Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: {-' aze_� Q
Name: (owner) \Aia.L� Co cra<«n3 SUBDIVISION $vFshL� LOT # ai)
System Installer: —TEn aw.J Registration #
Basement with plumbing: ElGarage Number of Bedrooms
Type of Water Supply: ❑ Community 14 Public ❑ Well Distance from well 1 004 feet
System Type: 7=L) 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.
Ibis 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
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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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system an the above capti ed property.
Type of system: ❑ Conventional X Other �r7'— �ci"d� Septic Tank: 1 pOH gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch ISO feet ditches 15 feet ditches 21161; X6 inches
French Drain Required;, Dne
Authorized State Agent 7� WIS Date