OPNTE# I5' Harnett County Department of Public Health 24541
PERMIT # Operation Permit
New Installation)%) Septic Tank Nitrification Line ❑ Repair ❑ Expansion
Q PROPERTY LOCATION: LzE , —�E Pct
Name: (owner) 1 R v.,7 v s -4y%U T 5 SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _>
Type of Water Supply: ❑ Commum Public ElWell Distance from well feet
System Type: G Types V and VI Systems expire in 5 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 Imorovement Permit and construction Authorization
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional oper,
IV. Operation:
L'Zs
conditions, maintenance and reporting.
V. Other. IriovsE Tu%tm taa '10'Fru eY Prn.^wvs�i-c� R_P.a.
❑
J
Cao
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
r
T 60 f
Type of system:
❑ Conventional Other "Tt"
Cii\P 1 Septic Tank: 100 0
gallons Pump Tank: gallons
+a
No. of
exact length width of
D
Drainage Field
ditches 3
4
feet ditches -'I�j inches
French Drain Required: - Linear
s
E
fa
LZS Ll
4f
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional oper,
IV. Operation:
L'Zs
conditions, maintenance and reporting.
V. Other. IriovsE Tu%tm taa '10'Fru eY Prn.^wvs�i-c� R_P.a.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional Other "Tt"
Cii\P 1 Septic Tank: 100 0
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches 3
of each ditch '?S 0 feet ditches 3
feet ditches -'I�j inches
French Drain Required: - Linear
feet
Authorized State Agent -"'� \ "r)S Date