OPHTE# t 0 Harnett County Department of Public i,ealth
PERMIT # Operation Permit 21 6 0 6
New Installation 'l, Septic Tank A Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Nc.~~wEsr
Name: (owner) Kv.a.~a R>&2-L- SUBDIVISION Gyt:~y.,~~w LOT # 11
System Installer: M 1 N4f-- Q-ej Registration #
Basement with plumbing: ❑ - Number of Bedrooms
Type of Water Supply: ❑ Community )?I, Public ❑ Well Distance from well 100 feet
System Type: `R 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.
rills 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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1. Performance:
II. 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 ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: X Conventional ❑ Other
Subsurface No. of exact length
Drainage field ditches of each ditch 1 1 d feet
French Drain Reauiredr.'-.
Alarm ❑ H201-ine ❑ PWR Line
Septic Tank: ~ M o gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent ~w P-C-'N 5 Date O 1) 6
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