OPHTE#1G-5-3T)TD, Harnett County Department of Public Health 24319
PERMIT # l ODeration Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION.Of 1Al1.vE
Name: (owner) C—P,>FS %V)LQwc 1N C, SUBDIVISION _ h,4 JOT # 114�
System Installer: .8 ro • Registration #
Basement with plumbing ❑ Garage -KNumber of Bedrooms 3
Type of Water Supply: ❑ Community >� Public ❑ Well Distance from well feet
System Type: = a 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.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all unditions of the Improvement Permit and Comtmtlion Authorisation
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Ny,N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the �seqw�}age dispa system on the abovq captioswd property.
Type of system: ❑ Conventional -K Other lmml �(1.. Qui' Septic Tank: TOOL) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field of each ditch 30Ci feet ditches feet ditches 1,C M inches
French Drain Require ear feet
Authorized State Agent '%� -� wy� Date