OPHTE# I a-S-~sTas Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 0 3
New Installation X
Septic Tank )F] Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
M oaxs 9,~
Name: (owner) 4
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SUBDIVISION ~
~E~nct4 LOT #
System Installer: CX -~5
S-, ~c t, t~ ti Q
Registration #
Basement with plumbing: ❑
Garage 'U Number of Bedrooms
3
Type of Water Supply: ❑ Comm
unity `,~L Public ❑ Well
Distance from well Lo 0
feet
System Type:
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.
finis system has been installed in
with applicable North Larolma beneral Ntatutes, Nules for Newage treatment and Utsposal, and all conditions of the
Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N~X
IV. Operation:
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1=-Z- 4'a ty~ Septic Tank: 1® O e1 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of el 0 Drainage Field ditches 3 of each ditch feet ditches feet ditches ' g inches
French Drain Required: ine eet
Authorized State Agent qr--`s~5 Date e)-