OPHTE# 4 - z706 Harnett County Department of Public Health
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PERMIT # Z% 5"3i Operation Permit 2 2 0 8 6
New Installation Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION-,~54 1A75 61 A,ge-,e ,.3
Name: (owner) ~ 0-7;jrr llfej,,h-h SUBDIVISION LOT # 2-
System Installer: &tit.S :rL« Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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.
Inns 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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1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
V. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
Alarm ❑ H20Line ❑
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Septic Tank: !QC, D gallons Pump Tank:
width of depth of
ditches feet ditches
PWR Line
gallons
inches
french Drain Required: Linear feet
Authorized State A n _
Date 1'2 ' {S ' l i
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