OPHTE# \S"S31SJS Harnett County Department of Public Health 2 3 9 91
PERMIT # 0 eration Permit
'F�!( New Installation Septic Tank >Nitrification Line 11Repair [I Expansion
PROPERTY LOCATION: Gz�t
Name: (owner) SUBDIVISION C) Puro LOT # SlS
System Installer: 7- OOIc Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms y
Type of Water Supply: ❑ Community t& Public ❑ Well Distance from well k6 O feet
System Type: 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.
cors SYSOM hm oven mstamd in complmna with appliable Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Pennit and Consmumon Authorization.
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PERMIT CONDITIONS
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No�K
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 sewage disposal system on the above'rc,a��,,b,oned operty.
Type of system: El Conventional Other C Vic" �T`a1 Septic Tank: gallons Pump Tank: gallons
Subsurface of enact length width of depth of
Drainage Field ditches of each ditch 3 O 0 feet ditches 3 feet ditches �� inches
French Drain Required:_ feet
Authorized State Agent �� " ��� QG Date 4 ))h b