OP RHTE#V~-5 Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 2 7
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: S \CD o 1, GD t.~ Q.t3
Name: (owner) ")Nrt .mss- (Wc.;''\4N SUBDIVISION )uter-,Ecz X11 LOT # 5
System Installer: 7'~-~, oct T a s ~1 n,c3i ~v e. Registration #
Basement with plumbing: ❑ Garage "15< Number of Bedrooms3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well O OO feet
System Type: = 12j 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
IL 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: RFPAICt,P R C5 6, op~O~ C-yv -Sr' Y~.CCC) .1-0Ep CAP ~'ocz Eka<: t 4+ 5 1dAl
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other 9V m2 7 0 F_Z Fz-ow Septic Tank: 1 DO Q gallons Pump Tank: N 0 0 0 gallons
Subsurface No. of exact length width of depth of
Drainage Field dit es 1 of each ditch c~+a feet ditches 3 feet ditches inches
French Drain Required: ® -LiDear feet
Authorized State Agent Date q IZ5A N
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