OPHTE# i I Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 1 2
New Installation'R Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) IR-~-SC-Kk O Osvs> SUBDIVISION LOT #
System Installer: 71'w.1 ~tiG~~•`~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Communi Public 'X Well Distance from well 140 feet
System Type: ~1. 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
N' 7
North l.arolma heneral Statutes, Rules for Newage Ireatment and
and all conditions of me improvement rermlt and t.onstructlon Authorization.
0 lJ c~lU~'~s
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 ❑ Ng~~
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 Other Septic Tank: k 0®O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 100 feet ditches feet ditches - aLi inches
French Drain Reauired: r feet
Authorized State Agent Q. -'5 Date 131 i`11 1