OPHTE# ICS -S 2~`1~7 Harnett County Department of Public Health
PERMIT # Operation Permit 21 5 7 2
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M~
Name; (owner) KEN N , c s SUBDIVISION E~r0QD LOT IftQ)
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System Installer C it i s S-s cxu,~o Registration #
Basement with plumbing. ❑ Garage )i< Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1a0 feet
System Type: Types V and YI 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 Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
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 ❑ NoV '
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑
N20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional "'K Other F_ -2- 4P- Septic Tank: 100 0
Subsurface No. of gallons Pump Tank: gallons
(1, exact length width of depth of
Drainage Field ditches of each ditch s a feet ditches
French Drain Required: Uwjr feet feet ditches inches
Authorized State Agent ~ eE-s Date 1