OPHTE# Harnett County Department of Public Health
PERMIT ` Operation Permit 2 2 41 6
New Installation X\ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Doc-5
Name: (owner) SUBDIVISION _f~zc Fszs (R. s?r. E, LOT # c15
System Installer: Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tiQ ® feet
System Type: a 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
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 ct
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional A Other S tSl4s Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch Go feet ditches feet ditches inches
near feet
French Drain Required:
14
Date
Authorized State Agent ~ . t_0