OPHTE# 10 s a~ 11i~ Harnett County Department of Public Health
PERMIT # X06 Operation Permit 21 61 4
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NCa:-~
Name: (owner) C jmbec~,-P, -o V\(' s SUBDIVISION LOT # ~t5
System Installer. o ~~O-N >v Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community 19\ Public ❑ Well Distance from well a o 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.
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.
YES
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1. Performance:
11. Monitoring.
III. Maintenance:
IV. Operation:
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 ct
maintenance and reporting.
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned pro
Type of system: ❑ Conventional 1~ Other C"lo mg ~Q ~Q v ic"Z- Septic Tank: I CC) d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 each ditch I 00 feet ditches 3 feet ditches 6_ inches
French Drain Reouired;z~-, h '~titPt~
Authorized State Agent 9f---N"\5 Date
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