OPHTE# 07 Harnett County Department of Public Health
PERMIT # 0 eration Permit 21 5 3 0
Rl" New Installation Septic Tank P'litrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~.cw t etc ~i
Name: (owner) T 7' SUBDIVISION ~ c rC . A LOT # 8
System Installer: /1 (Zj c Registration #
Basement with plumbing ❑ Garage 2" Number of Bedrooms -1--
Type of Water Supply: ❑ Community El' Public ❑ Well Distance from well feet
System Type: -T17-~Gj 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.
Ihis 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.
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PERMIT CONDITION-
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
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.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage dispos~ system on th above ptioned property.
Type of system: ❑ Conventional Other 21- Septic Tank: wo gallons Pump Tank: l`~y gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Q" feet ditches :3 feet ditches /5 - 2 ~ inches
French Drain Required: Linear feet
Authorized State Agen L Lam-- ~iL C ~'e~~F Date - 11 `/12-al d
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