OPHTE# 1a-5'a-c5u1 Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 3 0 6
New Installation X Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t yu-cyEti 12-0
Name: (owner) E~c.NNc,S SUBDIVISION LOT #
System Installer: L An cL
I "5 - w-t,P C. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public 'X Well Distance from well 50 feet
System Type: ~:r 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.
mis system nas been installed in
with applicable North larolma beneral Statutes, Rules for Sewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
rLnrrss wnuntviu.
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
French Drain Required: _ lets
Septic Tank: 1C)(5 t5
width of
ditches
Authorized State Agent Date
Alarm ❑
H20Line ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
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