OPHTE#,,Z,°!~-- 1°7 Harnett County Department of Public Health
PERMIT # Z&6g0 / Operation Permit 2 2 2 7 7
[3/ New Installation Septic Tank I~ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) S ft?-L2 ~2 SUBDIVISION LOT #
System Installer: r( Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: /r> 447-..!` 107 C-- 4'2- ~ypes 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.
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This system has been installed in compliance #'Rh applicable North Carolina General Statutes,
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
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 ❑ 1-1201-ine ❑
Following are the specifications for the s disposal system on the above captioned propery.
Type of system: ❑ Conve ewa
ntional Other Zb-'b1c,1'Y-A)0CX7,6-P '-I. Septic Tank: % 000 gallons Pump Tank:
Subsurface No. of exact length YI width of depth of P~
Drainage Field ditches of each ditch feet ditches -3 feet ditches Z'7
French Drain Required: Linear feet
Permit and Construction Authorization.
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PWR Line
gallons
inches
Authorized State Agcy- 6. I'V (.bzr Date 6 vei -12.