OPHTE# C> 9-X'~- 61.3V7L Harnett County Department of Public Health
PERMIT # Operation Per it 21 8 2 8
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: eJ-
Name: (owner)b~PV1=~Ic~~~o SUBDIVISION LOT #
System Installer: /fe 7---%A Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ( Pd
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: G- 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.
finis system has peen installed in compliance with applicable north l.arolina beneral statutes, Rules for sewage Ireatment and Disposal, and all conditions of the Improvement Permit and (instruction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
II. 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. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa disposal yytem on the above captioned property.
Type of system: ❑ Conventional Other rc C., Ckc-,e k- Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 13 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent w~,. If e Date f _
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