OP RRHTE# C 9-5 = X.ZY Harnett County Department of Public Health 21 161
PERMIT # a Eyi 0 Operation Permit
Z'New Installation Septit Tank ❑ Repair Q'~ Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) CL%.v, Ac ST Lc:,... A b-;_-,,Jy--,,-{SUBDIVISION LOT #
System Installer: 1~ C . Registration #
Basement with plumbing: ❑ Garage i2f_ Number of Bedrooms
Type of Water Supply: ❑ Community ePublic ❑ Well Distance from well feet
System Type: = 3 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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PtKMII I.UNUII TUNS:
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewaeisposal system on the above captioned property.
Type of system: ❑ Conventional 11, Other Qv r C CC Septic Tank: 1 006 gallons Pump Tank: 00 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch J.3 0 feet ditches feet ditches / ~ inches
French Drain Required: linear feet E ized State Agent IL, e~._. C= ~w_ Date /
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