OPHTE# tb- 5-13 Harnett County Department of Public Health 23982
PERMIT # a$763 Operation Permit
New Installation X Septic Tank X Nitrification Line 11 Repair El Expansion
PROPERTY LOCATION: �yr4ic0,5,a6 0Q_
Name: (owner) lac:y–GG. \-)0r''16s L -LC— SUBDIVISION OPur 0nr5 LOT # -_
System Installer: oo E G psc sv 50— Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community 1�k Public ❑ Well Distance from well l OG feet
System Type: 73:3. 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 renewalr
this system has been Installed in compliance with applicable North Carolina General Statuses, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
I REpc� Q I 3
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. 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:
06L%Y rs �].A N Q)" uflooL S oc eF A40 use "I"S=ON I-9a>`tG O Rzv", SI, OE,
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ FAIR Line
Following are the specifications for the sewage disposal system on the above captione4roperty.
Type of system: ❑ Conventional i Other C�_sl trQfa2 Cdr Septic Tank 10 0 Sj' gallons Pump Tank I OOO gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch -OLL1.5 feet ditches 3 feet ditches )4 inches
French Drain Requi Linear feet
Authorized State Agent 5 Date 44
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