OPHTE# Harnett County Department of Public Health 2385
PERMIT #ti5Q1- Operation Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: U vEA,1; X' -L5 9s1
Name: (owner) _QAw,s \Aci ' SUBDIVISION LOT #
System Installer: CJc�vL-r', ( 49 Registration #
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Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well ) O O feet
System Type: �'' --'v 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.
Ihis 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.
II. 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. 5vpor_y 3�r L)-oe'� 92'-4E
❑ D -Box ❑ Pump ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abovecaptioned property.
Type of system: ❑ Conventional X Other Pow a t o E �— F-04 Septic Tank: SC500 gallons Pump Tank: sb00 gallons
Subsurface No. of exact length width of depth of
Drainage Field �iteMe. 4 _ of each ditch � C) feet ditches 3 feet ditches tg inches
French Drain Reauired:_-� Gnear feet
Authorized State Agent \�F+.S Date
15-5-34W
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