OP RHTE# I~ ► Q Harnett County Department of Public Health 21 3 91
PERMIT # k a Operation Permit
New Installation Septic Tank ❑ Repair C6-Nitriliication Line ❑ Expansion
PROPERTY LOCATION:_w~ )q
Name: (owner) 0'j C- der.°~`P SUBDIVISION ~,,,r~cs K~S1 (<<s LOT #
System Installer: `cd Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms
Type of Water Su I : ❑ Community - F)l Public ❑ Well Distance from well feet
System Type:„ Types V and V1 Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
17-111 anon noinieo m compuance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
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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.
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional IQ I Other ~~(t 4 Ccr-- Se tic Tank:
Subsurface No. of p gallons Pump Tank: gallons
exact length width of depth of
Drainage Field ditches __I of each ditch OCR feet ditches
French Drain Required: feet ditches- inches
Linear feet
Authorized State Agent ' - ~~L- Date , a G - 1 Z)
2- _ L;D `