OPHTE# I (Q- > —.fez Harnett County Department of Public Health 24485
PERMIT # ZqN `3 Operation Permit /
L� New Installation Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION:,Ck14o& 0/ y
Name: (owner) SUBDIVISION SUBDIVISION LOT #
System Installer: /3r,o Registration #
Basement with plumbing: ❑ Garage JNumber of Bedrooms
Type of Water Supply: ❑ Community LTJ Public Lil/Well Distance from well /OO ' feet
System Type:Types V and VI Systems expire in 5 years.
(1n 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 Authoriution
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PERMIT CONDITIONS
1. 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 ❑
Following are the speci ions for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches Z_ of each ditch 200 feet
Alarm ❑
H2OLine ❑
PWR Line
Septic Tank: /%trD gallons Pump Tank gallons
width of depth of
ditches 3 feet ditches inches
French Drain Required: Linear Net
Authorized State AgF.pt.��-� ? Date f']
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�a•��fs iC". rte .i
16-5-39482 (1) 16-5-39482 (2) 16-5-39482 (3) 16-5-39482 (4) 16-5-39482 (5)
16-5-39482 (6) 16-5-39482(7) 16-5-39482 (8) 16-5-39482(9) 16-5-39482 (10)
16-5-39482(11) 16-5-39482(12) 16-5-39482(13) 16-5-39482(14) 16-5-39482(15)
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-39482 (20)
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-39482 (25)
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16-5-39482 (26)