OPHTE# 't~ Harnett County Department of Public Health
PERMIT # ~6 1 Operation Permit 2 2 3 0 5
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: tg,~
Name: (owner) uG"N-2°Y SUBDIVISION CzMCGu '-r Q^5 LOT # ro
System Installer: C)-c%5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well L tQ 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.
this system has been installed in compliance with applicable North Carolina General Statutes, Rullps 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.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
IV. Operation:
If yes, see attached sheet for additional operation co6ditions, maintenance and reporting.
V. Other:
❑ D-Box ❑ Pump ❑
Fallowing are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional "X Other iF2- ~s.nwr
Subsurface No. of exact length
Drainage Field - 7liitch 4 of each ditch S ® feet
French Drain Required~~ y ear feet
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: MZO gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches -111I3~ inches
Authorized State Agent \ ` ").%5 Date
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