OPHTE# �3 Harnett County Department of Public Health
PERMIT # Operation Permit 22635
New Installation X Septic_ Tank Nitrification Line El Repair ❑ Expansion
PROPERTY LOCATION: I f N ��
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms 5
Type of Water Supply: ❑ Communi X Public ❑ Well Distance from well i ®® 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
PHMII CUNDIBIUNS:
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
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: gallons
Subsurface o. of exact length width of depth of
Drainage Field ditches of each ditch t feet ditches 3 feet ditches inches
French Drain Reauired: n\ t
Authorized State Aeent_ Date � B D�-, I i