OPHTE# 14-5-530) Harnett County Department of Public Health 23663
PERMIT #
Operation Permit
New Installation _�V Septic TankNitrification line ElRepair ElExpansion
PROPERTY LOCATION: cs G*
Name: (owner) \"y%414 ,-V'� 2U 0 t b N SUBDIVISION ) 2� 1126 0 6-C LOT #
System Installer: ®camo P,_v,<)43,a;4 ;�' Registration #
Basement with plumbing: ❑ Garage, Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well , 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.
Jr.1LCll1 11- Um, IIR[dI111 III
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV
wlm applicable north larolma General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Construction Authorization.
\<,aI'-'1'F 0G,L13y L_rJ
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 be
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal � stem on the above captioned property.
Type of system: ❑ Conventional Other 1_.—
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
French Drain Required: nr fppt
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: 10(n ® gallons Pump Tank: gallons
width of depth of
ditches feet ditches—� inches
Authorized State Agenty" --Ij , w �
_ Date 6[r7 .