OPHTE# foZ-s -~-$32.) Harnett County Department of Public Health
PERMIT # `i 5~- Operation Permit 2 21 7 7
ZNew Installation 2 Septic Tank 1 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /?J
Name: (owner) o,✓~!i/ /~on~~1 SUBDIVISION )1k la~. ~Gr>"..~ LOT # ~
System Installer: 7-1~ ,4;~1 ),2/,j Registration #
Basement with plumbing: ❑ Garage C~Number of Bedrooms
Type of Water Supply: ❑ Community U2/Public ❑ Well Distance from well feet
System Type: LU 3 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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rtKMII LUNUIIIuNS:
1. Performance: System shall perform in accordance with Rule .1961.
Il. 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 ❑ H201-ine ❑ PWR Line
Following are the specifications for the sews dispossystem on the above captioned property.
Type of system: El Conventional Other .v •+nn -lc C-- Z Flc) -J Septic Tank: co b gallons Pump Tank: /060 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches. 3 of each ditch 16 C) feet ditches 3 feet ditches ' 2 inches
French Drain Required: . - _ inear feet
Authorized State Agent - S1 ' Date I~
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