OPHTE# /7 7ab Harnett County Department of Public Health
PERMIT # a~ d Operation Permit 2 21 6 5
53/New Installation [a" Septic Tank 0'- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~~C¢-•
Name: (owner) SUBDIVISION LOT #
System Installer: ,e: e. Ll Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bed oms
Type of Water Supply: ❑ Community ❑ Public Well Distance from well AN" feet
System Type: =-G 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
with applicable north l.arohna beneral )tatutes, Nules for
treatment and Disposal, and all conditions of the
I
~t
Permit and Lonstruction Authorization.
PERMIT CONDITIONS:
C- L"C!
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑
Alarm ❑ H20Line ❑
Following are the specifications for the sews
ge
disposal system on the above captioned property.
Type of system:
,
❑ Conventional O
ther
Septic Tank: a G gallons Pump Tank:
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch 1 d feet
ditches feet ditches 1Z 0
PWR Line
gallons
inches
French Drain Required: Linear feet
c l
Authorized State Agent Date l 7,/Z°~Z
07-sr1-7 9oe)