OPHTE#- -ZS1~Ct~ Harnett County Department of Public Health
PERMIT #Operation Permit f, 2 2 2 6 6
New Installation Ej~ Septic Tank 9 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:r,~=s'7Z
Name: (owner) at ~ r SUBDIVISION LOT
System Installer: t 4~,A-S Registration #
Basement with plumbing: ❑ Garage Number of Be rooms 3
Type of Water Supply: ❑ Community ❑ Public Well Distance from well -5-d feet
System Type: O 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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1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
Following are the spe' i
cations for the sewage disposal system on the above captioned property.
Type of system: IJ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches y of each ditch ID feet
Alarm ❑ H201-ine ❑ PWR Line
Septic Tank: / Z 0 0 gallons Pump Tank: gallons
width of depth of
ditches feet ditches a tf inches
French Drain Required: Linear feet -
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Authorized State Ag~t_ Date - i 2-
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10-5-25146 (6) 10-5-25146 (7)
10-5-25146 (8)
10-5-25146 (9)
10-5-25146 (10)