OPHTE# 10-6--a Harnett County Department of Public Health
PERMIT # s~ Operation Pe~r-m-i-t 21 8 0 3
New Installation Its septic Tank ICJ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION
Name: (owner) SUBDIVISION cam; r , a.' f LOT # / 7 o
System Installer: -4 Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: a C 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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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operati on:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are tie specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other E2, Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches of each ditch
.-7_ feet ditches
French Drain Required: _ Linear feet
H2OLine ❑
gallons Pump Tank: gallons
depth of
feet ditches inches
PWR Line
Authorized State Agen,~~ _ f Date / //9 / o/°
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