OPHTE# IQ-5-ay4DG Harnett County Department of Public Health
PERMIT # a604 1-j Operation Permit 21 6 0 7
New Installation ~K Septic Tank ~4 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) owl v t ~a SUBDIVISION Ns~-~oa,9 LOT #
System Installer: `T,Ea 6aoW N Registration #
Basement with plumbing: ❑ Garage "~4 Number of Bedrooms y
Type of Water Supply: ❑ Community '~X Public ❑ Well Distance from well COO feet
System Type: , Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
this system has been mstailed 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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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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captionedrkroperty.
Type of system: ❑ Conventional , Other CIAKtoa (.Qv s c,~ 'A Septic Tank: 100 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches S of each ditch feet ditches 3 feet ditches JQ a~ inches
French Drain Reauired _ I innla ~inpr
Authorized State Agent t&1-5 Date 9 1a1)0
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