OPHTE #N—�> -5 -3 Harnett County Department of Public Health 23064
PERMIT # Operation Permit
New Installation 'N� Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: eta )z,:oa/Z Z2.
Name: (owner) a.r6,a` E5 cs ` -Q11A e 1 N Cr SUBDIVISION W ",t-21 -a %7T rat. LOT # C-7
System Installer: r-- sDDNE G An4-4C(I— Registration #
Basement with plumbing: ❑ Garage �14 Number of Bedrooms G
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well 10 Q) feet
System Type: Sl 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
rtKMII LUNDIIIUNN:
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 ❑ Na
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for
the sewage dispoA system on the ab ve capt�ed property.
Type of system: ❑
Conventional
X Otherm �,/
Septic Tank: t gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
di`tc`hes ^=—
1� of each ditch feet
ditches feet ditches inches
French Drain Reauired:
®�
°®\ L feet
Authorized State Agent ��wv��, Date