OPHTE# fit- 5~ab~6C~ Harnett County Department of Public Health
PERMIT # a-~ Operation Permit 2 2 7 3 7
New Installation X Septic Tank X Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: om
Name: (owner) ES 1 v y-C 0 va SUBDIVISION C- cu,t.;~ testa. Ss-0';SO r11 s LOT # Cb
System Installer: C~•c)!5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L-
Type of Water Supply: ❑ Community Public ❑ Well Distance from well V.® G 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.
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.
I Q.EPA~Cl ~-~I~
Gt~
V
DCDMIT fAlI tllTll111f.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N V%
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage dispos system on the above c~tioned property.
Type of system: ❑ Conventional Other Vcrw E._2 1-e,N Septic Tank: Sb4a gallons Pump Tank: 1406 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 7- feet ditches 3 feet ditches 36 J~ inches
French Drain Reauired:
Authorized State Agent_ S Date