OPHTE# /I- �-- -Z 987'5 Harnett County Department of Public Health
PERMIT Operation Permit 22564
Q'New Installation Z" Septic Tank Lr Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: % e1 ud
Name: (owner) SUBDIVISION LOT # 3
System Installer: JZr Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: .� G 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 aoolicable North Carolina General Statutes. Rules for Sewage Treatment and Disnosal. and all conditions of thr Imnrnvcmenr Parmir and r— trnrrinn a thnri -tinn
rtnrm WNUIIn NY
I. 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 conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional 19 Other L Z F% u1 Septic Tank: U v0 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch - feet ditches 3 feet ditches —3
French Drain Required: _ Linear feet
Authorized State Agen,�,�-.- �f (`ff i Date �d l2 L 3
PWR Line
gallons
inches
l
f�
I
iur f
tcK
T
f
� 1
rtnrm WNUIIn NY
I. 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 conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional 19 Other L Z F% u1 Septic Tank: U v0 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch - feet ditches 3 feet ditches —3
French Drain Required: _ Linear feet
Authorized State Agen,�,�-.- �f (`ff i Date �d l2 L 3
PWR Line
gallons
inches
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