OPNTE# Harnett County Department of Public Health 24765
PERMIT # 1"I 66`a— Operation Permit
New Installation '15k Septic Tank Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Dy -O \35�
Name: (owner) Tv—% L x QoN S SUBDIVISION Me %m t: ELL Qn'�- eL- LOT #
System Installer: " ih u M b Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well feet
System Type: _..III % 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 complianu with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and commission Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other 91- qL-0 w Septic Tank: 0 xJ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch C feet ditches 3 feet ditches YT '-34 inches
French Drain Required. inear feet
Authorized State Agent Y G'AS Date
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