OPKE Harnett County Department of Public Health 23022
PERMIT Operation Permit
New Installation Septic Tank] Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION �{ LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage C> Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well 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.
ims system has peen mstaueo in compuan
with appucanie North tarouna beneral Itatutes, hutes for sewage treatment and Disposal, and all condltlons of the Improvement Permit and lonstructlon Authorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation c(
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are the sp cifications for the sewage disposal system on the above captioned property.
Type of system: ' Conventional
Subsurface No. of exact length
Drainage Field ditches r of each ditch � O"5 feet
French Drain Reouired: o LinearJect
Alarm ❑
H2OLine ❑
PWR Line
Septic Tank: I t) c7 C) gallons Pump Tank: gallons
width of depth of
ditches .� feet ditches �� °moo inches
Authorized State Agent Date )