OPHTE# 16.S-40-34--1 Harnett County Department of Public Health 24570
PERMIT # Q.q 133 Operation Permit
New Installation Septic Tank Nitification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NUQSKLL!
Name: (owner) C--t'—C'0 SUBDIVISION `fr\-%ooEns LOT# BS
System Installer: TFA 8q caw Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well feet
System Type: 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
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
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 sewage disposal system on the abov�,�aRtioq�d�property.
Type of system: ❑ Conventional Other LNAM2rG'L— Septic Tank: 10 0 v gallons Pump Tank: S 0 r 0 gallons
Subsud a No. of exact length width of depth of
Drainage field rhes of each ditch a�� feet ditches 3 feet ditches inches
French Drain Reauirel n n Linear feet
Authorized State Agent Date
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