OPHTE # > Harnett County Department of Public Health 23213
PERMIT # Operation Pe lt
I2 New Installation L Septic Tank /Witrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) �r—G� , -a1 1'� f�dYi SUBDIVISION LOT #
System Installer: C k� + ars Registration #
Basement with plumbing: ❑ Garage [ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 'il 6 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 c4pliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of
PERMIT CONDITIONS:
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.
Permit and Construction Authorization.
lb 60
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the s disposal system on the above captioned property.
ntional ewa
Type of system: ❑ Conve Other ItM 5' Septic Tank: —10 61- gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches `� of each ditch .7"� feet ditches ?i feet ditches inches
French Drain Required: Linear feet
Authorized State ent �°�"�"° Date
F
13 -5 -32686 (2)
13 -5 -32686 (3)
13 -5 -32686 (4)
13 -5 -32686 (5)
13 -5 -32686 (6)
13 -5 -32686 (7)
13 -5 -32686 (8)
13 -5 -32686 (12) 13 -5 -32686 (1)
13 -5 -32686 (9)
13 -5 -32686 (10)
13 -5 -32686 (11)