OPHTE# Harnett County Department of Public Health
2
PERMIT # Operation Permit 2 2 01
New Installation 'K Septic Tank )k Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: McZo ,c s,iQ
Name: (owner) SUBDIVISION LOT
yNu
System Installer: c) sus Q l--i-N55~ 1 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~Q 0 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.
PERMIT CONDITIUN):
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
th bove ca tioned roperty
PWR Line
Following are the specifications for the sewage disposal system on e a p p
Type of system: El Conventional Other r. 2~ Septic Tank: COO tY gallons Pump Tank: gallons
exact length width of depth of
Subsurface No. of inches
Drainage Field ditches 1 of each ditch feet ditches 3 feet ditches
French Drain Required: ~ w
Date
1e~\\1 it11~
Authorized State Agent