OPHTE# t "1-5-91-I'1S Harnett County Department of Public Health 24739
PERMIT # 1`�b�ly OOperation Permit
New Installation �K Septic Tank '�K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: G-Mgk,5S Q4\j(v(U%
Name: (owner) b110 S• C- e$6ft, SUBDIVISION LOT # 05
System Installer: -TE>, g0 -0-w t- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community )K Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
This. system has been installed in compliance with applicable Nord Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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 ElPump ❑ Alarm ❑ H2OLine 1-1PWR Line
Following are the specifications for the sewage disposaltem on the above c i nedd rty.
Type of system: ❑ Conventional � Other t �sYS fat: e` Septic Tank: I i0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch I a feet ditches 3 feet ditches — inches
French Drain Reauired:_ -'noitm_ Lineacfeet
Authorized State Agent Date