OPHTE# r®1- Sr ate-) Harnett County Department of Public Health
PERMIT # ~-Caq Operation Permit 2 2 3 2 8
New Installation K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC. °l
Name: (owner) N(&n NSS
A C1UMM\ °4 C 5 SUBDIVISION t N , GEta ~o %f_ LOT #
System Installer: Q)n N5 'TSL~C.\P,wfl Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community XPublic ❑ Well Distance from well 1oG feet
System Type: o, 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.
11. 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:
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Ez <,L-ow Septic Tank: \000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches-_ f each ditch "7Q feet ditches feet ditches S~'ay inches
French Drain Reouirfd~": feet
Authorized State Agent ~y ~ Rs~ Date 9A)1\
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