OPHTE#U4 - 5- aI 817 Harnett County Department of Public Health 2 0 6 8 7
PERMIT # Operation Permit
ew Installation Septi Tank ❑ Repair C'~trifcation Line ❑ Expansion
PROPERTY LOCATION: ~~tid~rarI-
Name: (owner) ~~r ~~~~4•~tJ SUBDIVISION C t o cS'~owt~n s LOT # 2
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community RT-Public ❑ Well Distance from well feet
System Type: ~ (11 - 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.
ims system nas oeen msraoea to compoance with applicable north larohna beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
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Permit and Construction Authorization.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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.
Following are the specifications for the sews disposal) Stem oq the above captioned property.
Type of system: ❑ Conventional lvr Other !C Septic Tank: gallons Pump Tank: gallons
Subsurface No. of 13 exact length width of depth of
Drainage Field ditches of each ditch 151-o feet ditches 3 feet ditches 3C) inches
French Drain Required: Linear feet
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Authorized State Age Date 7 Z~