OPHTE # 19 -5-73�4 � H -0 Harnett County Department of Public Health 23566
PERMIT # Operation Permit
New Installation �, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
( CJ 7 fV PROPERTY LKATION:�—
Name: (owner) 7--4r4 SUBDIVISION LOT #a�
System Installer: 0cL!5�0v I -a Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L_
Type of Water Supply: ❑ CommunityPublic ❑ Well Distance from well " 0'0 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
rtKflll t.UNUIIIUNY
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal sjstem on the above captioned property.
Type of system: ❑ Conventional , Other C V) C W' Septic Tank: 10
Subsurface No. of exact length width of
Drainage Field ditches --.of each ditch feet ditches
French Drain Required:' -hi mar feet
Authorized State Agent, ..�� Date
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches It -c-)- i inches
WA