OPHTE# Harnett County Department of Public Health
PERMIT # Operation P net /Nitrification 2 2 0 8 0
YNew Installation lJ Septic Tank Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,1i z, q 3 f? ,U ,,j; 1
Name: (owner) SUBDIVISION" LOT #
System Installer: '5'7°7f7a-- 'A A, Registration #
Basement with plumbing: El Garage umber of Bedrooms -3
Type of Water Supply: ❑ Community L1 Public ❑ Well Distance from well feet
System Type: Z5'9~,jlfi~t;~~r? x~T: 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.
[his 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
Z ~i
s
t rz ~ z
44 L. i
YtKMII LUNUIIIUNN:
1. Performance: System shall perform in accordance with Rule .1961.
IL 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 sew3ge disposal system on the above captioned property.
Type of system: ❑ Conventional Other 15 O bf) Septic Tank: 1010 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch )QQ feet ditches feet ditches Z4 inches
French Drain Required: Linear feet
Authorized State A t Date 0T)0-11