OPHTE#~g_~~a Harnett County Department of Public Health 21 2 4 3
PERMIT # a56L10 Operation Permit
New Installation )K,., Septic Tank ❑ Repair-K Nitrification Line CJ Expansion
PROPERTY LOCATION: Iv.)Ia.e C~,D
Name: (owner) SUBDIVISION LOT
System Installer: _W)Im" Nc ~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well i eoa 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.
This system has been installed in compliance with applicable North Carolina Genera) Statutes, Rules for Sewage Treatment and Disposal, and al( conditions of the Improvement Permit and Construction Authorization.
9G~
V10
PERMIT CONDITIONS:
I. 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.
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Following are the specifications for the sewage disposal system on the above capti d property.
Type of system: ❑ Conventional Other IZ'A (Q VIC.,,R ~c )
Septic Tank: X000 gallons Pump Tank:
Subsurface No. of exact length width of
Drainage field ditches depth of
of each ditch G O feet ditches 3 feet ditches A4- 11
French Drain Reouired: u .
gallons
inches
Authorized State Agent_ Date kbull0
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