OPHTE# �� Harnett County Department of Public Health
PERMIT # Operation Permit 22607
New Installation Septic Tank L- litrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) �-! r. SUBDIVISION LOT #
System Installer: Registration
Basement with plumbing: ❑ Garage ❑ ber of Bedrooms f�
Type of Water Supply: ❑ ic ❑ Well Distance from well 14�' t%' feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table 0i) 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, u es or ew red n I, and all conditions of the Improvement Permit and Construction Authorization
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
J®r
D -Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa a disposal s stem on th above captioned property.
Type of system:
El Conventional Other
Septic Tank: gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length T
of each ditch P i' feet
width of depth of
ditches . feet ditches "J inches
French Drain Required: Linear feet
6
Authorized State Agent f Date /" t