OPHTE# Harnett County Department of Public Health
PERMIT # ~~aaa Operation Permit 21 5 8 6
"X New Installation SepTic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION. ED-cv-,, 19-;N QG G. ()C
Name: (owner) SUBDIVISION _ Mt-p"Zo,,, V.,LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community -N, Public ❑ Well Distance from well 1bd 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.
ims system has been mstaffed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS-
L Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ No 7
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z V ov4 Septic Tank: Sbb0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 5 of each ditch Cab feet ditches feet ditches inches
French Drain Required: ?Z
Authorized State Agent Date R11 0 11
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