OPHTE# /-7 �,75' Harnett County Department of Public Health 23101
PERMIT # 02 �S 03 Operation Permit
ZrNew Installation Er Septic Tank EI 1
Nitrification Line ❑ Repair ❑ Expansion
/ PROPERTY LOCATION: 26.' -
Name: (owner) .-tom v 1 f . -.4:d,. SUBDIVISION ern ��s !e-�� LOT # S
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community VPublic ❑ 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.
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
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
l pLt
IQN I �
firms
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.
V. Other:
❑
D -Box ❑
Following are the specifications
for the
Type of system: ❑
Conventional
Subsurface
of
Drainage Field
ditches
French Drain Required:
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage dispoial system on the above captioned property.
@( Other y ". P 4v EZ Septic Tank: gallons Pump Tank: /Q O 0 gallons
exact length width of depth of
of each ditch feet ditches feet ditches /8 'a� inches
Authorized State Agent ' 4 :!! �1' Date
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