OPHTE# �- 1 Harnett County Department of Public Health 233
19
9
PERMIT # � 3` Operation, Permit
New Installation X Septic Tank . Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: (n C-NL I, yQ-
Name: (owner) i SUBDIVISION LOT #
System Installer: t�l���,�.Q Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms-3 _
Type of Water Supply: ❑ Community Public ❑ Well Distance from well i �_)O 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.
ims system nos oeen instaueo in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT fnNnITInNP
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
M
Tz
(' 2Pi1 -suc -L ti
ft o'
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1`12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 1 Other —TI -C CAA 39�' Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch C feet ditches feet ditches
French Drain Required . tinoa et-
Authorized State Agent ` V � �'`�� �`� X15 Date 7111
�r�, _`3 }�1���