OPHTE# l0-5 ~'O Harnett County Department of Public Health
PERMIT # Operation Permit 21 7 9 7
New Installation )iQ, Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) M, i c-,-,
System Installer: $<-2- c-~ k, sassy
Basement with plumbing: ❑ Garage Number of Bedroom
Type of Water Supply: ❑ Community Public ❑ Well
System Type:
(In accordance with Table V a)
PROPERTY LOCATION: L2M Ac cL
SUBDIVISION LOT #
Registration #
Distance from well- 1005 feet
Types V and VI Systems expire in S years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas been instauea in compliance wnn applicable north laronna t,eneral statutes, Rules Ior Sewage Ireatment and Disposal, and all conditions of the
vt`~~ \3 ~ 3a'C?
Permit and Construction Authorization.
a~Dll
rtKPlll LUNUII UNJ:
1. 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 ❑ NO
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage dispos system on the above captioned property.
Type of system: ❑ Conventional Other ~0 Pia ~Z- LO Septic Tank: 100 (3 gallons Pump Tank: 100'?o gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 's feet ditches '3 feet ditches inches
French Drain Reauired: Linea-feet
Authorized State Agent \~~gr,, 5 Date