OPHTE#-//` ~ZVf.7 Harnett County Department of Public Health
PERMIT # h~~Zo Operation Permit 2 2 0 7 7
❑ New Installation ❑ Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: 11z" q 7.
Name: (owner) SUBDIVISION LOT # / 3
System Installer: - Registration #
Basement with plumbing: El Garage umber of Bedrooms
Type of Water Sup ly: ❑ Community V public ❑ Well Distance from well feet
System Type: YTypes 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, 6ules for Sewage treatment and
and all conditions of the improvement Permit and lonstructlon Authorization.
Z7"
13°
tv~'
nrou~T rnumm~ur
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D-Box ❑
Pump ❑
Alarm ❑ H201-ine ❑ PWR Line
Following are th
e specifications for the sewa disposa~4stem on the above caption^e-d ~roperty.
'
Z
Type of system:
❑ Conventional Other
1 1;t
k (Area
Septic Tank: /
00 gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches q
exact length
of each ditch feet
width of depth of
feet ditches Z" inches
ditches j
French Drain Required: Linear feet
-vim o-"°h-s
Authorized State Ag t Date
.m
11-5-27097 (1) 11-5-27097 (2) 11-5-27097 (3) 11-5-27097 (4) 11-5-27097 (5)
17
.0011,
11-5-27097 (6) 11-5-27097 (7) 11-5-27097 (8) 11-5-27097 (9)
lie
11-5-27097 (11) 11-5-27097 (12)
11-5-27097 (10)