OPHTE# ~q- -5W- Z4 63 Harnett County Department of Public Health 2 4 9 2 4
PERMIT # Operation Permit
ew Installation i - S is Tank ❑ Repair & Nitrification Line ❑ Expansion
PROPERTY LOCATION: ►Vj t^(ZJ
Name: (owner) tt-lkc. v~ SUBDIVISION :D ..f Fx2 Fy ~t~cc LOT #
System Installer. Registration
Basement with plumbing: ❑ arage N tuber of Bedrooms
Type of Water Sup>I ❑ Community Public ❑ Well Distance from well- J-n Z>_ feet
System Type: (t (~c 0, A S a 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.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ No-16
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Y. Other.
Following are the specifications for the sewa a disposal s s on the above captioned property.
Type of system: ❑ Conventional Other % 1 t L:11 /).5 Septic Tank: Q 'Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches o? ~ inches
French Drain Required: Linear feet
Authorized State Agent l.A Date '
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