OPHTE# la-°S-a'1Zi5~ Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 3 9
New Installation 4<,, Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: h1 C.Z)~°7
Name: (owner) t,E~et.,G-~ C.u r•,rn g K4 Gs SUBDIVISION `~rN GEr.I ~o~w LOT # \a>
System Installer: C~-t. s 5-s~~cz- AaQ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well 100 feet
System Type: _ 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.
Iris system has been installed in compliance with applicable North Larolina beneral xatutes, Rules for )ewage Ireatment and Disposal, and all conditions of the Improvement Permit and Lonstructlon 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property. 'Xy Type of system: ❑ Conventional Other Z. __LC1_ Septic Tank: \_ZD0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ® feet ditches feet ditches inches
French Drain Reouired~s ~~tinear feet
Authorized State Agent \~\~.v,'` QG Date V
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