OPHTE# Harnett County Department of Public Health 2 0 6 2 7
PERMIT # oZ S Operation Permit
New Installation tic Tank ❑ Repair Nitrification Line ❑ Expansion
Name: (owner) V>6 ~ l f
System Installer: ` S 7~~ zl
Basement with plumbing: ❑ Garage
Type of Water /SIupply: ❑ Community
System Type:
(In accordance with Table V a)
IV. Operation:
V. Other.
umber of Bedrooms
Public ❑ Well
W
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other: J
Subsurface system operator required? Yes ❑ No 16
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
# / ~ z,
Permit and construction Authorization.
Following are the specifications for the serer disposaL4ystem on the above captioned property.
Type of system: ❑ Conventional ~ Other A> A Septic Tank: gallons Pump Tank: JK s30 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches _ feet ditches I V . inrhnc
rent ram egwre : Linear feet
Authorized State Agent ~ Date
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
PROPERTY LOG ION:
SUBDIVISION 0~ , 2 e LO
Registration #
Distance from well G_ feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.