OPHTE# /c-s- Z:5-6y3 Harnett County Department of Public Health
PERMIT # 24aC `7` Operation Permit 2171
❑ New Installation ❑ Septic Tank Nitrification Line ❑ Repair Expansion
PROPERTY LOCATION:3./1011/ .
Name: (owner) $ n SUBDIVISION S LOT # IT
System Installer: Registration #
Basement with plumbing: ❑ Garage 1Number of Bedrooms 3 ~ ZJ'~'Pej
Type of Water Supply: ❑ Community L~ Public El Well Distance from well feet
System Type: T12, 'Ca 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 Improveme
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
111. 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 sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other LY/c%s " krSeptic Tank: /gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Permit and Construction Authorization.
Authorized State / mk-ln'~ Date 6 Z I tti ° 10
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