OPHTE#-_0 9 - J~=~Z z7 ~ Harnett County Department of Public Health
PERMIT # Operation Permit 21 5 3 5
d New Installation L'_} Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCAJf~-~ I&
Name: (owner),;51 SUBDIVISION .
LOT # I!7
System Installer. F c F Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community ~ublic ❑ Well Distance from well feet
System Type: 777-(,- 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.
ims s stem 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 Auth"don.
r o
i
C
~
P~ r 2
3
u~aw
i
4 t
PERMIT CONDITIONS: 'Y u o
1. 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 ❑ 1-1201-ine ❑ PWR Line
Following are the spec
ifications for the sewadisposal system on the above captioned property.
Type of system: El
Conventional f"1 Other _C-- Zc-
Septic Tank: (jin'~ gallons Pump Tank: gallons
Subsurface
D
i
Fi
ld
No. of exact length
width of depth of
ra
nage
e
ditches of each ditch feet
ditches feet ditches -7 'Y inches
French Drain Required:
Linear feet
Authorized State Agent../- • ZLLL- , 11Z61-Z1
Date 7/,Z
7-7 2?
I
p b,k
i ~g1 f ~ ~ tom'
1
Aw-
Ilk
-IN