OPHTE# 10 Harnett County Department of Public Health
PERMIT # c) Operation Permit 2 2 2 2 0
E(New Installation Septic Tank d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: G Icy ZI
Name: (owner) SUBDIVISION W-6J4et,- -LOT # J'
System Installer: i o f C. tee Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 9
Type of Water Supply: ❑ Community 2"-Public ❑ Well Distance from well 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.
ims system nas peen mstaneo in compuance wim appucame norm carouna aenerai
rtes, naves for )ewage Treatment and uisposal, and all conditions of the
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Permit and Construction Authorization.
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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:
❑ 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 V Other & 2- di J Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches -9 of each ditch -7 J__ feet ditches 3 feet ditches % 6' 2- inches
French Drain Required: Linear feet
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Authorized State Agent ewu.. _ N Date _ 7/X
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