OPHTE# / -s 3 Harnett County Department of Public Health 23262
PERMIT # 027 9 Operation Permit
I?r New Installation 2'-Septic Tank 2r�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: JVr 5
Name: (owner) �2c�cc>\ 1'� �u�y SUBDIVISION ( I l LOT # I/
System Installer: Registration
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .T
Type of Water Supply: ❑ Community Z'—Public ❑ Well Distance from well /00 feet
System Type: 77E ) 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
PtKMI I IUNUI I IUNS:
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 ❑ No 21"
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box ❑
Pump ❑ Alarm ❑
11-12O1-ine ❑ PWR Line
µ
Type of system:
El Conventional Other
C �s:cdr Septic Tank: 000
gallons Pump Tank: gallons
�'Jtu
No. of
exact length width of
` kt p��. i
Drainage Field
ditches
of each ditch acv feet ditches 3
feet ditches /G° 3 y inches
_ Ll- l
6
3
� tt
PtKMI I IUNUI I IUNS:
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 ❑ No 21"
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box ❑
Pump ❑ Alarm ❑
11-12O1-ine ❑ PWR Line
Following are the specifications for the sews disposal system on the ab ve captioned property.
�iaro.5@r
Type of system:
El Conventional Other
C �s:cdr Septic Tank: 000
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch acv feet ditches 3
feet ditches /G° 3 y inches
French Drain Required: Linear feet
Authorized State Age — Date
/�J`'3�31-�