OPHTE# Harnett County Department of Public Health
PERMIT # 2~ b Operation Permit 21756
New Installation ~ Septic Tank ; Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) moms,";' yNv-~ SUBDIVISION N ~rrN Pa LOT # ► la
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 Cl 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.
,,us system nas peen mstauea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the
3 57 910 A
12G~ '~-E~-pA~2 ~
3<)
Go~~ cam
PERMIT rnNnlTIMIC.
Permit and Construction Authorization.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ _
Following are the specifications for the sewage disposal system on the above captio ed property.
Type of system: ❑ Conventional `t< Other Ccac 3 Septic Tank: %QC~ gallons Pump Tank:
Subsurface No. of exact length "7 width of depth of
Drainage Field ditches of each ditch - feet ditches 3 feet ditches _
French Drain Required:, Liitw feet
Authorized State Agent Date
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~
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
) o
PWR Line
gallons
inches
Y^ r K
-41
moo'
77-
TIQ
~ d