OPHTE# 11 - - Z~ z Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 0 8 5
D New Installation 9 Septic Tank E Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Yr e
Name: (owner) SUBDIVISION LOT
System Installer: l •ck- 1 r Registration #
Basement with plumbing: ❑ Garage 2~Number of Bedrooms
Type of Water Supply: El Community L'J° Public ❑ Well Distance from well feet
System Type: V 7~: _ Types V and VI Systems expire in 5 y rs.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to xpi ration for permit renewal.
This system has been installed in compliance with applicable North C rolina General Statutes, Rules for Sewe Treatmen and Disposal, and all conditions of the imp ovement Permit and Construction Authorization.
1/1 II
,i
PERMIT CONDITIONS:
1. Performance: System shall perform in accoi
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. 0
Subsurface system operator rt
If yes, see attached sheet for
IV. Operation:
with Jule 61.
f
? Yes No ❑
maintenance and reporting.
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the sp fications for the sewage disposal system on the above captioned property.
Type of system: [ Conventional ❑ Other Septic Tank: 100 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditchesZ inches
French Drain Required: Linear feet
Authorized State Ag Date _ 12--17,-11
~~-rz-It - 11- SY- Z6,002 -
11-5-26882 (7) 11-5-26882 (8) 11-5-26882 (9) 11-5-26882 (1)