OPNTE# ) 3 -F- 3 s 2 -5 Harnett County Department of Public Health 23072
PERMIT # .9, t7;3 ) Operation Permit
New Installation l' Septic Tank 54 "hitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: � �
Name: (owner) C % /-0-i2 SUBDIVISION 46Lt -,, - LOT #
System Installer: 4z- Registration #
Basement with plumbing: ❑ Garage (ONumber of Bedrooms
Type of Water Supply: ❑ C_ommuni ®°'Public ❑ II Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) wner 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 f Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtnrul CUNUII UNY
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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal stem on he above captioned property.
Type of system: El Conventional C"OtheY Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length r� width of depth of
Drainage Field ditches of each ditch 9 n feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent .42 --- �� A11Z A �� } � � Date