OPHTE# Il J'a--?- Harnett County Department of Public Health
PERMIT Operation Permit 2 2 0 3 6
New Installation Y Septic Tank R" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Lyoc'- d''c` 1"
Name: (owner) f~a t~be0.~s C-41711ve- 4~ SUBDIVISION LOT #
System Installer: O~'~' S~~^' lz0, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -
Type of Water Supply: ❑ Community C4' Public ❑ Well Distance from well feet
System Type: 7u 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.
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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FERrm t.unuriivrik
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sewer disposal system on tl a above captioned property.
Other C- Z--)--/-W Septic Tank: Q G 0 gallons Pump Tank: gallons
exact length width of depth of
of each ditch mac' feet ditches 13 feet ditches 02 q inches
French Drain Required: Linear feet
Authorized State Agent Date