OPHTE# t Q -s ayu~ Harnett County Department of Public Health
PERMIT # Operation Permit 21 5 9 0
New Installation 'TK Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) N U <L---E5 Qou,l-off SUBDIVISION S G ~Nr* 5 LOT # S
System Installer. Spy Pic oc~~- Registration #
Basement with plumbing: ❑ Garage ~P4 Number of Bedrooms
Type of Water Supply: ❑ Community 'V, Public ❑ Well Distance from well NCO 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.
ims system nas peen mstauea in compliance wim
r
north larolma beneral statutes, Rules for sewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authonzation.
~5 A 1 i;-~
rtKmi l IUNUIIIUN):
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ~9, Other CZ F~4 w Septic Tank: '10 0 a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches f each ditch feet ditches _3
feet ditches inches
French Drain Reauired: teePt
Authorized State Agent ec---i'15 Date