OPHTE# Q5-s` 2 X.JT~ Harnett County Department of Public Health 21 12 5
PERMIT #~r Operation Permit
New Installation Septic Tank ❑ Repair L7 Nitrification Line ❑ Expansion
PROPERTY LOCATION:? wrrf
Name: (owner) w,+.~O~,-l~+d t►oe~cr SUBDIVISION ~,cs.ve-e / V~lFe,r LOT #
System Installer: Te d &-v wA Registration #
Basement with plumbing: ❑ Garage 0' Number of Bedrooms Y
Type of Water Supply: ❑ Community LR"'Public ❑ Well Distance from well feet
System Type: Q 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 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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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 I'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. fLj 4 ..tr Ci fl z w4 1 : xr C L.ecIr Pd
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Following are the specifications for the seewwV dispo syste on the above ca tion property.
Type of system: ❑ Conventional L''i Other ~ C~Cw6~ Septic Tank: /at gallons Pump Tank: ~0
"W ~ gallons
Subsurface No. of exact length width of depth of
Drainage field ditc e of each ditch Gt6 feet ditches feet ditches 2 inches
French Drain Required: _ limn w~fety
Authorized State Agent ~w~ Q~~~s Date
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