OPHTE# Harnett County Department of Public Health
PERMIT # a G1 Operation Permit 2 2 2 0 5
New Installation I~T Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: `~•1
Name: (owner) W J n SUBDIVISION LOT # SOS
System Installer: 2,,~ o N!~, Q L_ V r,g~,A c. Registration #
Basement with plumbing: ❑ Garage 'CW Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1®G 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
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PERMIT CONDITIONS:
I. 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 ❑ N lq
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Permit and Construction Authorization.
V. Other. s9sm ~,ez~ lv $,c';~
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional Other UrnP ~o _ 2 , Septic Tank: 00 o gallons Pump Tank: IO®® allons
Subsurface No. of exact length width of g
Draina a Field ditches depth of
g of each ditch ® feet ditches 3 feet ditches - 1 c}, inches
French Drain Required\.~~
Authorized State Agent_ "'~"Z~ y~& Date ►
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