OPHTE# 65 - S- 1340 Harnett County Department of Public Health 2 0 4 4 5
PERMIT # ZZ7'it Operation Permit
New Installation E~ Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LO(ATION:Slj-76
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Name: (owner) Z SUBDIVISION LOT #
System Installer: 1• -5 )EA ~-5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public Gds Well Distance from well 82 feet
System Type:, qtr rz~ ;„tticg,.- 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
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions If the
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Permit and Construction Authorization.
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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.
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z59br [xt r, t jtg Septic Tank: 16bC? gallons Pump Tank: gallons
Subsurface No. of exact length I width of depth of
Drainage Field ditches of each ditch - :1t;- feet ditches- feet ditches Z Z inches
French Drain Required: Linear feet
Authorized State Ag nt Date - D
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