OPNTE# r®� ��Harnett County Department of Public Health 23609
PERMIT # 2d Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �&tl'I ° i / %5 C/U,6 4,13
Name: (owner) c Z , LL C_ SUBDIVISION LOT # Z Z
System Installer: a5 Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community � Public ❑ Well Distance from well feet
System Type: and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact althh Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolin Gene al Statutes, Rules for Sewage Trea Afid Dispo I, allconditions�mprovement Permit and Construction Authorization.
A f
PERMIT CONDITIONS:
I. Performance:
If. 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��s''stem on the above captioned property.
Type of system: El Conventional Other /��lU Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 20 feet ditches feet ditches inches
French Drain Reauired: Linear feet
Authorized State Agyi -� Z A C7 Z
Date �6--2q —/ S'
14-5-35068 (1)
14-5-35068 (2)
14-5-35068 (3)
14-5-35068 (4)
14-5-35068 (5)
14-5-35068 (6)
14-5-35068 (7)
14-5-35068 (8)
14-5-35068(9)
14-5-35068 (10)