OPHTE# IS -S- 3�63`� Harnett County Department of Public Health 24464
PERMIT # Operation Permit
New Installation '1� Septic Tank )S� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOLATION: W cm -N 2-1 Ga exR tS 'Do -
Name: (owner) H ^ 1-1 'C) Nst � C N a M E 5 SUBDIVISION \� a,_y g, ao rG LOT # 1
System Installer. 15 S-a,.Registration #
Basement with plumbing: ❑ Garage )< Number of Bedrooms 3
Type of Water Supply: ❑ Community .Nt Public ❑ Well Distance from well 1 CtO feet
System Type: —T—), r j 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.
This system has been installed in compliance with applicable North Carolina General Statute; Rules for Sewage Treatment and Disposal, and all wnditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS -
1. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. Q (W71v
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❑ D -Box ❑
Pump ❑
Alarm ❑ 11201.1ne ❑
PWR Line
Following are the specifications for the
sewage disposal system on the abovq
captionedSproperty.
Type of system: El Conventional
-A�
Other CHgM66n,
sa' Septic Tank: 5000 gallons Pump Tank
gallons
Subsurface
exact length
width of depth of
Drainage Field ditches 1
of each ditch
350 feet ditches 3 feet ditches
I a inches
French Drain Required:
tinp
Authorized State Agent _ml yS Date
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