OPHTE# s5- arl81 Harnett County Department of Public Health
PERMIT # 2 U 33 0 Operation Pernit 2 2 01 2
New Installation L Se is Tank Nitrification Line El Repair El Expansion
t PROPERTY LOCATION: a~
Name: (owner) SUBDIVISION LOT # J~
System Installer: / she lel f Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 2""Public ❑ Well Distance from well feet
System Type: .M QN- 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.
11. Monitoring: As required by Rule .1961.
111. 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 sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional ❑ Other d'-k q o ar- Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches UZ of each ditch 120 feet ditches ? feet ditches 3Q inches
French Drain Required: Linear feet
Authorized State Age w t~ ~ Date