OPHTE# /01_y_.1, ~ o1~ - Harnett County Department of Public Health
PERMIT # ck Operation Permit 2 2 3 6 8
0ew Installation i_I Septic Tank Vitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: y rJ°ele-1 .
Name: (owner) V~ l ~f t`~~M SUBDIVISION LOT # r,5
System Installer: L,~,-.rr-V a~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3-
Type of Water Supply: ❑ Community V"Public ❑ Well Distance from well 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, 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.
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 0 eration•
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V. Other:
❑
D-Box ❑
Following are the specifications for the
Type of system: ❑
Conventional
Subsurface
No. of
Drainage Field
ditches
Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sew disposal system on the abo a captio ed property.
IJ✓ Other ~v r~ Ce: i- Septic Tank: gallons Pump Tank: gallons
exact length width of depth of
r of each ditch `J feet ditches 3 feet ditches 2y inches
French Drain Required: Linear feet
,tea. /1t~f~ Date . °G2-
Authorized State Agent
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