OPHTE# J it® 3 ,010f Harnett County Department of Public Health
PERMIT # 2 72\2— Operation Permit 20611
❑ New Installation ❑ Septic Tank L?-Ni ifcation Line Repair ❑ Expansion
PROPERTY LOCATION:_ 'ez_.. - z
_
Name: (owner) - SUBDIVISION LOT #
System Installer: �° Registration #�
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public ®?'Iell 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
rtn111 LVNUIIluny:
I. 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 L�-
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
D -Box ❑ Pump ❑ Alarm ❑ s H2OLine ❑ _ PWR Line
Following are the speciF ions for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 0 feet ditches feet ditches or inches
French Drain Required: Linear feet
Authorized State Agent W- Date Q l