OPHTE# $5 Harnett County Department of Public Health
PERMIT # ak9 13 Operation Permit 2 2 3 4 6
New Installation )Rr Septic Tank , Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: pocs
Name: (owner) S, bra y ta., V)0 rte- U~~ SUBDIVISION 1 r Q.oc G,£ LOT #
System Installer: a,.s Registration #
Basement with plumbing: ❑ GarageA Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: Z1 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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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No_X
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
ns, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal,,, syYstem the above captioned property.
Type of system: ❑ Conventional Other C.~.W Septic Tank: `d®®
Subsurface N . exact length width of
Drainage Field ditches of each ditch C~e3 feet ditches -
French Drain Reauired: \ tee
1201-ine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches 34-K inches
Authorized State Agent___ ~01 Date
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