OPHTE# 1/0 =2532 7 Harnett County Department of Public Health
PERMIT # 2607 Operation Permit 21 7 2 6
New Installation ❑ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: is-32. r c tt
Name: (owner) - wc Ag,sw- , ~ ~c SUBDIVISION / LOT # 1
System Installer: ~z Registration #
Basement with plumbing: ❑ Garage C/ Number of B rooms
Type of Water Supply: ❑ Community ® Public Well Distance from well feet
System Type: ZWo 3zy :w &-'T.~ ;17 C f' 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 Improvement Permit and Construction 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 ❑
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other
Subsurface No. of exact length
Drainage Field ditches of each ditch 12O feet
H2OLine ❑
PWR Line
Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Age C - Date
Alarm ❑
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