OPHTE#r~J ,-0q Harnett County Department of Public Health 19976
PERMIT # 5 Operation Permit
New Installation ~9- Septic Tank ❑ Repair L_ Nitrification Line ❑ Expansion
PROPERTY LOCATION: It 2
Name: (owner) C ~,..r..~ SUBDIVISION t-i"I dSh,rti LOT # I I C-
System Installer. LO ~ S-rr .t t_rv Registration # U s t~t t
Basement with plumbing. ❑ Garage Jn Number of Bedrooms 4
Type of Water Supply: ❑ Com pity 54 Public ❑ Well Distance from well S feet
System Type: P. ,r.n- c-~ CIL 12 Types Y and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ns system has been inst*4 in compia" with aWicabk North Carolina Gen" Smtute% Rules for Sewage Treatment and tAsposai, ad al cosditiors of the Improvement Permit a d Comtrsscdon AudwrizauK
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PERMIT (ONDITIONS: 2<c r t t
rerformance: system snass perform in accordance wim Rule .iy6I.
Monitoring., As required by Rule .1961.
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 sewage dispos system on the above ca boned pro
perty.
Type of system: ❑ Conventional 'Other lrt 2 19LJ Size of tank: Septic Tank: o gallons Pump Tank: 3--) gallons
Subsurface No. of ` exact length width of depth of
Drainage field ditches t of each ditch J feet ditches feet ditches IY inches
french Drain Required: Linear feet
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Authorized State Agent Date ? F d 2S
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