OPHTE# lu-5 �as� t' Harnett County Department of Public Health
23965
PERMIT # Operation Permit
New Installation �R Septic Tank Nitrification Line ElRepair El Expansion
PROPERTY LOCATION: Dc"
Name: (owner) SUBDIVISION Tci oT til�,o6C— LOT #
System Installe arc-, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms ")
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well feet
System Type: TS c 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.
Iles system has been installed In Compliance with applicable Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. 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 a
IV. Operation:
V. Other.
A I
A
I
2
rruvS6
9
2
KL�hS vUC.�i p(SLQY A N C—'.
maintenance and reporting.
❑ D -Boz
❑ Pump ❑
Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications for
the sewage disposals tem an the above captioned
property.
Type of system: ❑ Conventional
Other a �'�tlw
Septic Tank:
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field" i�tches
of each ditch G 6
feet ditches 3
feet ditches )� inches
french Drain Requires.
�ear feet
Authorized State Agent Date
I717m_