OPHTE# I S- Harnett County Department of Public Health
23565
PERMIT # 30� Operation Permit
New Installation 'K Septic Tank XNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) t�.�t,�i-���vns� �F�.ca-1 SUBDIVISION 5`'���` LOT #
91-1
System Installer: Co asp Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -�
Type of Water Supply: ❑ Community >< Public ❑ Well Distance from well 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.
11113 spmm uas ueeu msrauea in compuance warn
D[DMIT f/1\ID1Ten11f
north laronna beneral Statutes, Rules for Sewage Treatment and
and all conditions of the
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 ❑ NON
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Permit and construction Authorization.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ptloned operty.
Type of system: ❑ Conventional Other C1-'(--!m6E12 �" Septic Tank: LC®0 � gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field di es t of each ditch tfeet ditches feet ditches k "3O inches
French Drain Reauired: I inaa�a 44t
Authorized State Agent ��\� ����''� \ ee--A-5 Date 3
IS- 5--�653Y�