OPHTE# I C- 5-3961'-' Harnett County Department of Public Health 24553
PERMIT # 180110 Oneration Permit
New Installation *1 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Q'ct.oPFll7c�E_5 SUBDIVISION LOT # S
System Installer: —R—'ars tl\w) -b Registration #
Basement with plumbing: ❑ Garage f5l< Number of Bedrooms —L
Type of Water Supply: ❑ Community A Public L1 Well Distance from well feet
System Type: �T is 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 in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
1
i
fill USE
i
v
c
L. Oars R.6N c.t: a.9
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No�K
If yes, see attached sheet for additional operation cc
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field
French Drain Required:
maintenance and reporting.
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
�sewage disposal system on the above c phoned �rW�erty.
.q Other 1-t tnenSbC ��'t't J Septic Tank: s 000 gallons Pump Tank: gallons
exact length width of depth of
1 of each ditch Sod feet ditches 3 feet ditches inches
Linear feet
Authorized State Agent Date 5