OPHTE#15-5'31C'i) Harnett County Department of Public Health 24075
PERMIT #1Si Operation Permit
New Installation N Septic Tank Nitrification Line El Repair ❑ Expansior
PROPERTY LOCATIO :�t�sGery
Name: (owner) +LLCI-JL4— NOME SUBDIVISION 9+Tosy5 LOT # 5/
System Installer: Wila 0-7 o r, %-5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 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.
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 Contraction Authorization
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
111. Maintenance:
IV. Operation:
V. Other.
I
System shall perform in accordance with Rule -1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alorm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposaljsystern on the above ca tionedloperty.
Type of system: 11 Conventional Other �iP lt— �En / Septic Tank: l (JOG gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field—ditches of each ditch l afeet ditches 3 feet ditches ao-3G inches
French Drain Require.(� _ Linear feet
Authorized State hent Date