OPHTE# ,`~=ate n Harnett County Department of Public Health
PERMIT # ^1 Operation Permit 2 21 3 7
tl~ New Installation _K Septic Tank K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M~
Name: (owner) YC,0 0 t_► SUBDIVISION Su ,Nrnc=Q1~~1 z LOT #
System Installer: b ~a0e; ~)"Une'\tAG Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t ®o feet
System Type: _T_) T 14 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 Construction Authorization.
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PERMIT fnNn1Tinw.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
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 X Other ~Z '~OrJ Septic Tank: t ® CS p gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches - y f each ditch 5C~ feet ditches 3 feet ditches inches
French Drain Reauired: ~~'~Ifn~Y roar
Authorized State Agent 7!~~ ~Ilk V-a-11>15 Date 1
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