OPHTE# Harnett County Department of Public Health
PERMIT Operation ~Peer-mitit 2 21 6 3
C'New Installation LJ Septic Tank R"' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION:_'': R.I.
Name: (owner) 11c:.1 1611"Id .url Z-12,_ SUBDIVISION LOT # /aJ_
System Installer: r '§u; k'j- Registration #
Basement with plumbing: ❑ Garage 2'^Number of Bedrooms 3
Type of Water Supply: El Community 2/Public ❑ Well Distance from well feet
System Type: ?Y= G 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
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1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ PWR Line
Following are the specifications for the sewpge disposal system o~J the above captioned property.
Type of system: ❑ Conventional Z Other E7 ~I .the
Septic Tank: D 14 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch S_0 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent //Z" Date 1,71 l
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