OPHTE# H -J_- 3,'-1dY Harnett County Department of Public Health 23450
PERMIT # Operation Permit
New Installation R'—Septic Tank f , Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:L rnc_I:t ��r �..�� Rpt.
Name: (owner) SUBDIVISION LOT # J
System Installer: Q44—`,f Registration #
Basement with plumbing: ❑ Garage ❑ Ifiumber of Bedroom
Type of Water Supply: ❑ Community 1Z Public ❑ Well Distance from well feet
System Type: Zlrg 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
rtNrlrl LUNIUMUN):
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conveni 01 Other Septic Tank: IW O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 140 feet ditches feet ditches — / 6 inches
French Drain Required: Linear feet
Authorized State Agen ew Date/co1�15'
!�G'a e-
t�
t
Vy I
rtNrlrl LUNIUMUN):
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conveni 01 Other Septic Tank: IW O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 140 feet ditches feet ditches — / 6 inches
French Drain Required: Linear feet
Authorized State Agen ew Date/co1�15'
/ V-5--