OPHTE# Harnett County Department of Public Health 23715
PERMIT # o28If- 7 Operation Permit _/
LR" New Installation LJ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOICATION: R" a'r f''Cd
Name: (owner) B%7/ Clwk SUBDIVISION Co -i I ,G feta rg J LOT # 79
System Installer: T e/ t&P �: c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community I -Public ❑ Well Distance from well feet
System Type: llCo Types V and VI Systems expire in S 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:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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.
❑ D -Box ❑ Pump ❑
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H2OLine ❑
PWR Line
Following are the specifications for the sew!pdIsposal system on the /aBove cpptioned property.
Type of system: El Conventional 1' Other`�u: "ll,ti C/14P e, Septic Tank: CV 0 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /S`o feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age 4Ys ww "a lfj- Date /o 1,3 / Qi/
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