OPHTE # Harnett County Department of Public Health 23379
PERMIT # 'aD_7i,5 Operation Permit
New Installation 14, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) Yn Co \gn, 10"j
System Installer: oq, >® Pt_v
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well
System Type: i ?
(In accordance with Table V a)
PROPERTY LOCATION:.
SUBDIVISION I LOT #
Registration #
Distance e from well !®d feet
Types V and VI Systems expire in 5 years.
Owner 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 for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other '- Fl-�'w Septic Tank: J00 c�'
Subsurface No. of exact length width of
Drainage Field ditches , of each ditch a_ \-o feet ditches
French Drain Required: r_
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
Authorized State Agent \ \` tk�, Date 11' `►1) V-'
19~ 5- at\