OPHTE# 11 - 5 1AZ,'&do Harnett County Department of Public Health 25067
PERMIT # Operation Permit
New Installation '1< Septic Tank '1< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: aO Noe F,L;hmo flrt_
"1 Co
Name: (owner) X1'rtSCC2K-> LN30SUBDIVISION _, LOT #ac�%-5
System Installer: Y—Ltow 'Do a Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Vic, 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 nettled in compliance with appliable North Carolina General Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construmon Authorization
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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
If yes, see attached sheet for additional operation a
❑ O -Box ❑
following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field — kcbes
French Drain Reawatin _
maintenance and reporting.
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the abyyve capeue�d property.
�1 Other Septic Tank 1130 0 gallons Pump Tank: gallons
exact length width of depth of
of each ditch at1 O feet ditches feet ditches a inches
3
Linear feet
Authorized State Agent R-GTh Date
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PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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
If yes, see attached sheet for additional operation a
❑ O -Box ❑
following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field — kcbes
French Drain Reawatin _
maintenance and reporting.
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the abyyve capeue�d property.
�1 Other Septic Tank 1130 0 gallons Pump Tank: gallons
exact length width of depth of
of each ditch at1 O feet ditches feet ditches a inches
3
Linear feet
Authorized State Agent R-GTh Date
1
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