OPHTE# 1 - 7335 Harnett County Department of Public Health
23967
PERMIT # Operation Permit
New Installation Septic Tank Nitrificati line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ne CDo vO �\T4
Name: (owner) V)\ji SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms 3
Type of Water Supply: ElCommuni Public ❑ Well Distance from well 100 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 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
PERMIT CONDITIONS:
I. 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 ❑ NoX
If yes, see attached sheet for additional operation a
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑
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I'ccDovGA�n RIS
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface_ No. of exact length
Drainage Field
French Drain I
of each ditch Q--�.5 feet
H2O1-ine ❑
PWR Line
Septic Tank: IaOG gallons Pump Tank gallons
width of depth of
ditches 3 feet ditches inches
Authorized State Agent �� ������1� Date