OPHTE# Harnett County Department of Public Health
PERMIT Operation Permit 2 2 7 3 8
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1-1 w-i
Name: (owner) SUBDIVISION &-X)w-N15 0_s> LOT # 4d
System Installer: 9 G ~ Registration #
Basement with plumbing: ❑ Garage `K Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well l~ feet
System Type: --om 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.
5,
1-1 ¢s~~;s NorL~
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No,X
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Su suace-- No. of
Drainage Field
French Drain I
Authorized State Agen
Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sewage disposal system on the above caption property.
Other r> rL- L. 'U A. Septic Tank: ~b®® gallons Pump Tank: gallons
exact length width of depth of
~~bw of each ditch c'~- 4) O feet ditches feet ditches inches
feet 6c-Ldo es0r'jrzP'1.. k.AXZ
Date
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