OPHTE# �5-5=',6"997 Harnett County Department of Public Health 23971
PERMIT # ��� Operation Permit
�K New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
M PROPERTY LOCATION: H y
Name: (owner) SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 4 Public ❑ Well Distance from well 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.
, .... „d —" n.>,dneu n, mnipudina nnn dppnsawe none uronna ueneral atamreS, aures for sewage neatment and msposal, and all conditions of the Improvement Permit and Construction Amhorization.
I. 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 ❑ N11-"�
If yes, see attached sheet for additional operation a
maintenance and reporting.
❑ D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
Other P m r ;. E Z Fd w
Septic Tank: SOOCs gallons
Pump Tank: 1000 gallons
Subsurface �Noof
exact length
width of
depth of
Drainage Field ditcha
3 of each ditch feet
ditches �_ feet
ditches oil-_. inches
French Drain Required:
Linear feet
Authorized State Agent �!s PLIaS (`oL-wQL sofW� Date
I