OPHTE# 11°5-'a6C1b'S Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 7 0 3
New Installation -f Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N v g__r12-j
Name: (owner) ~ta~r~ewe~s --t~~4 QF~sr. c~prr ; SUBDIVISION CZ0 0zsc~ LOT # r,,),
System Installer: ~Qc__oc_iL Registration #
Basement with plumbing: ❑ Garage U Number of Bedrooms 3
Type of Water Supply: ❑ Community 15< Public ❑ Well Distance from well 1®C0 feet
System Type: -XZ 5 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
NtKPII I IUNVII IUNN:
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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: S-sS' e" C" g~2oo" Wou L
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other 9.Z zIsrg Septic Tank: l 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 50 feet ditches feet ditches c'+1' inches
French Drain Reauired:
Authorized State Agent w Date
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