OP RHTE#SL'- 5 Harnett County Department of Public Health 23964
PERMIT # a$13"1 Operation Permit
New Installation :K Se8c Tan Nitrification Line ElRepair El Expansion
PROPERTY LOCATION: voG5 �
Name: (owner) SUBDIVISION Ice- ME-, s enocE LOT # s 4
System Installer: e. Registration #
Basement with plumbing: ❑ Garage �K Number of Bedrooms s -'s
Type of Water Supply: ❑ Community „Public ❑ Well Distance from well 1150 feet
System Type: 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 on compliance with applicable Reach Urolma General statutes, Rules lot sewage treatment and Unposal, and all conditions of the Improvement Permit and lonsnucnon Amhonnnon
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ IK
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal s stem an the above captioned property.
Type of syste . Conventional Others F1—aw Septic Tank: 10`*,G gallons Pump Tank: gallons
Subsurface of exact length width of 3 depth of
Drainage Field ditcl of each ditch 60 feet ditches feet ditches 12 inches
French Drain Reouire� Linear feet
Authorized State Agent NiNk, Date