OPH T E # 01 - T2D Harnett County Department of Public Health 21 1 7 8
PERMIT # - Operation Permit
New Installation )~-Septic Tank ❑ Repair~* Nitrification Line ❑ Expansion
PROPERTY LOCATION: 2-1 / n~s Name: (owner) ! SUBDIVISION I n LOT #
System Installer:
~ o j2i Registration #
Basement with plumbing: ❑ Garage '16 Number of Bedrooms _ 3
Type of Water Supply: ❑ Comm" ty Public 1:1 Well Distance from well k 0 feet
System Type: + Types V and VI Systems expire in 5 years.
(In accordance wit 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 (or Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
III. Maintenance:
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 -
N yes, see attached sheet for additional operation'cAditions, maintenance and reporting
Following are the specifications for the sewage disposal tem on the above captioned property.
Type of system: ❑ Conventional - Other Li ~ ~ C l . t.4
Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of ~
Drainage Field ditches of each ditch feet ditches 3_ feet ditches I t ~11 V inchm
French Drain Required: linear feet
Authorized State Agent Date
IV. Operation:
V. Other:
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