OPHTE# Qg-s az~l Harnett County Department of Public Health
PERMIT # as ~~s Operation Permit 21 5 3 6
P- ew Installation "e tic Tank FttNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) e t ~s 4°~~~ (f SUBDIVISION S' LOT # 18,r-
System Installer: Registration #
Basement with plumbing: ❑ Garage ;~KNumber of Bedrooms ?
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: cl 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.
u >psmu nes ueea insianea in
PrRMIT rnwhITlnltc.
wim applicable Rorth larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and [onstruction Authorization.
1. Performance
II. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No 2r
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewwa,gee disposal system on the bove captioned property.
Type of system: El Conventional ld Other C Z . , Septic Tank: /Oo 0
Subsurface No. of exact length width of
Drainage Field ditches of each ditch feet ditches
French Drain Required: Linear feet
Authorized State Age 1_;1
Date
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of f
feet ditches 02 7 inches
< a-
r
~k
'Pie
'3 ter ` -;a
o t A
A
ti
4
g~ -l
fem.
3~ $ F
~ - n
F ..4Y # x~ !
4
Off
y 8 C- 1
r
~aq s tR
.