OPHTE# tea- a3ass Harnett County Department of Public Health 213 9 0
PERMIT # Operation Permit
New Installation Cg-,Septic Tank ❑ Repair K Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) c~ct lc~~ i3mc SUBDIVISION C ~rvyn,. LOT #
System Installer. 5 2• ckIr1-e Registration #
Basement with plumbing. ❑ Garage-,4LNumber of -Bedrooms 5
Type of Water Su pl : ❑ Community JZI, Public ❑ Well Distance from well ~J feet
System Type: C"- 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Qsposal, and all conditions e, V\- 0 ft -V of the Impro ement Permit and Construction Authorization.
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other - E[ Z' t.✓
Subsurface No. of Septic Tank: gallons Pump Tank: gallons
Z exact length width of depth of
Drainage field ditches of each ditch - feet ditches
feet ditches c7 inches
French Drain Required:
linear feet
Authorized State Agent C~ L~s f Date 7 ~ a ~ 3
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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