OPHTE# /3- 5 =�zz�? Harnett County Department of Public Health 23095
PERMIT # vZ %��� Operation Permit
EB/New Installation D�Septic Tank ICI Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �eCf•
Name: (owner) SUBDIVISION i LOT # �3
System Installer: i nr�0 14 ` v « Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms •
Type of Water Supply: ❑ Community C2"Public ❑ Well Distance from well feet
System Type:�L b 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 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 LONDITIOV
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 sewa dispos syste on the above aptioned property.
Type of system: ❑ Conventional Other �a�rv0 � CZ /acJ Septic Tank: Q ®v gallons Pump Tank: j00 gallons
Subsurface No. of exact length width of depth of -/
Drainage Field ditches S of each ditch feet ditches -2 feet ditches /8 ' 7 inches
French Drain Required: "- Linur feet
Authorized State Agent Date `,M -0
/ ,3 -5 -32-221