OPHTE# d<u-3 = jgJiL Harnett County Department of Public Health
PERMIT Operation Per it 21 81 9
[2' New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) lam=/'" SUBDIVISION 1-f4c,,<..r ,e.`.~ LOT # /7/
System Installer: )74-c,,../ Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms
Type of Water Supply: ❑ Community Z'-Public ❑ Well Distance from well feet
System Type: V (3- 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
with applicable North Carolina beneral Statutes, Rules for Sewage Ireatment and uisposal, and all conditions of the Improvement Permit and lonstructlon Authorization.
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DCDMIT rnkinITMIC.
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other C?- F/- Septic Tank: / 00 0
Subsurface No. of exact length width of
Drainage Field ditches of each ditch feet ditches
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches y`a
inches
French Drain Required: Linear feet
1
( 27A
Authorized State Agent,- v° . l Date
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