OPHTE#/L(- -5- —3LIIA 43 Harnett County Department of Public Health 23496
PERMIT # z8°meg Operation Permit
L`/ New Installation L9` Septic Tank 2/Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 9!=.
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 2"Public ❑ Well Distance from well feet
System Type: act c v Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conte t Health Department 6 months prior to expiration for permit renewal.
anis system nas peen mstanea in
wim appucame norm t,aronna t3enerai mtutes, KUM for sewage treatment ana tnsposae, ana an conatuons of the Improvement rermit ana lonstruction Authorization.
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 21' Other L's%, / 6GZ UG� C_� rcQ ,� Septic Tank: 100 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch / -s--o feet ditches feet ditches ZY inches
French Drain Required: Linear feet
Authorized State Ag \ Z'�� `�- Date