OPHTE# -Z l Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 2 7 0
7/"'New Installation L/er Septic Tank C0/~ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5e- 8,4._J5'
~lddl r'~
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community LEI Public ❑ Well Distance from well feet
System Type: rG ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) 7 /f Owner must conealth 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
rtKMI l IUNUII IUNJ:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961. ZIL HT? 8
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional 17 Other ) 47" Septic Tank: 1060 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches ~ feet ditches Z inches
French Drain Required: Linear feet
1% A
Authorized State A Date
"~~`G l z'
r
r
C
M
12-5-28561 (2)
12-5-28561 (3)
12-5-28561 (4)
1
12-5-28561 (1)