OPHTE# %S® Harnett County Department of Public Health
PERMIT # i�a°� Operation Permit 22915
New Installation 'K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
t PROPERTY LOCATION:,v��-
Name: (owner) 7P, c;)-Nczt_E You"Q SUBDIVISION LOT #
System Installer: LP-'Qp- t 5 }jP�Qe C Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms L+
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 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.
ma system nas peen installed in compliance with applicable north tarolma jenerai statutes, rules for sewage ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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 ❑ N
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
ns, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional y Other -Z Septic Tank: 10 C> 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field of each ditch feet ditches feet ditches $ inches
French Drain Requir*? — ar�fe��
Authorized State Agent �N" \\ �5 Date
13 - 5 -31 C,Vk