OPHTE# 10 Harnett County Department of Public Health
PERMIT #
Operation Permit
2 2 71 4
New Installation '~q Septic Tank X Nitrification Line ❑
Repair ❑ Expansion
PROPERTY LOCATION: ~Nwi3-'1',4
Name: (owner) \rj -1 c-; N
or5 or-A
SUBDIVISION
LOT #
System Installer: ~t tc~ or5
~Lv ~a~N
Registration #
Basement with plumbing: ❑ Garage
N 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.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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:
RU ~
t_~'~ '.v Q.;Gri_ t,\ "3 G.
❑
D-Box
❑ Pump ❑ Alarm
❑ H20Line ❑ PWR Line
following are the speci
fications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
A Other I- -Z- vw
Septic Tank: lam gallons Pump Tank: 1006 gallons
Subsurface
No. of
exact length
width of depth of
3
0L~
Drainag-Ftef
ditches
of each ditch feet
inches
feet ditches
ditches
French Drain Required:
,;zz ear feet
Authorized State Agent Date 10