OPHTE# /~-°s =a.8wf--7 Harnett County Department of Public Health
PERMIT # v `T 07 Operation Permit 2 21 8 5
"New Installation 'Septic Tank ONitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: E t ( Z-~ c-,-r-.ed.
Name: (owner) k v :SUBDIVISION ~we~} - LOT # -7
System Installer: A 4 k 4,4, ---4-~„= Registration #
Basement with plumbing: ❑ Garage 2 "Number of Bedrooms y
Type of Water Supply: ❑ Community "Public ❑ Well Distance from well feet
System Type: :Z~ -b 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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PERMIT CONDITIONS:
t. rertormance: Nystem snap perform to accordance with Kule I Y61.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 04
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the ssppef lcations for the sewage disposal system on the above captioned property.
Type of system: Lid Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
PWR Line
Septic Tank: O U gallons Pump Tank: gallons
width of depth of
ditches -7 feet ditches U inches
French Drain Required: Linear feetr
Authorized State Agent Date 11,~7 X12
Alarm ❑ H20Line ❑
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