OPHTE# Io Harnett County Department of Public Health
PERMIT #Operation Permit 21 61 6
f New Installation '5~ Septic Tank ~q Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N--fN-,3E ~g-
Name: (owner) Co N-5 f o ~ j SUBDIVISION v r- LOT # _
System Installer: d -1 '5 S -v Q.---, c-~1 .,9 Registration #
Basement with plumbing: ❑ Garaged Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 16Q feet
System Type:T 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.
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Dro MIT ffl11t1ITIA IIf.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No X
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned
property.
Type of system:
❑ Conventional Other
E~ Z 'ice w
Septic Tank: I gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of +
depth of
Drainage Field
ditches
of each ditch b
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nn h]~
fPPt ditfh- J fee, X-1..
olh C):__L__
- ~~c~ ulttllC~ - - IIIl11C)
French Drain Required: ear
Authorized State Agent P~~~S Date D
Y
a
Ro"
a-