OPHTE# Harnett County Department of Public Health 24528
PERMIT # a'DLli Operation Permit
�f New Installation`. Septic Tank%] Nitrific 'on Line E] Repair ❑ Expansion
PROPERTY LOCATION: Dye -44 Phs
Name: (owner) L40 c,r bu SUBDIVISION LOT #
System Installer: -aa cT,y 5-1-19,tQE Registration #
Basement with plumbing: ❑ Garage 'W Number of Bedrooms t-1
Type of Water Supply: ❑ (ommum 'X Public El Well Distance from well feet
System Type: —2:) 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 no been installed in compliance with applicable Nonh Carolina General Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Comannsion 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 ca
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLme ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: EJ Conventional 'X Other 7'1,6: C�-av4 S Septic Tank: gallons Pump Tank: gallons
Subsurface Noe exact length width of depth of
Drainage Field ditches of each ditch I �4-U feet ditches 3 feet ditches inches
French Drain Reaui : ar feet
Authorized State Agent Date