OPHTE# a 2' 5Z Y0 Harnett County Department of Public Health 23009
PERMIT # Z1 `► , Operation Permit
Z" New Installation 2� Septic Tank ❑Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:5x zz i!j l4ml 40
Name: (owner) SUBDIVISION LOT # f
System Installer: - Oc7ti7�— ° Registration #
Basement with plumbing: ❑ Garage ❑ mber of Bldrooms 3
Type of Water Supply: El Community I Public P Well Distance from well feet
System Type: Z '4 r - Ln 0 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months for to expiration for permit renewal.
This system has been installed in
with applicable North Carona General
r�yy
II
t p�
I
Em
and Disposal. and all conditions bf the
Os4-
'Sit "Z u14 'f t
PERMIT CONDITIONS:
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:
Permit and Construction Authorization.
V. Other:
❑
D -Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional C3'°Other
3-� .I€�" 7�
Septic Tank: /02 gallons Pump Tank: gallons
Subsurface
No. of
3
exact length
width of depth of
Gy —1 lb inches
Drainage Field
ditches
of each ditch feet
ditches feet ditches
French Drain Required: Linear feet
ow
Authorized State Ag t Date
13 -5 -32419 (1)
13 -5 -32419 (2)
13 -5 -32419 (3)
13 -5 -32419 (4)
13 -5 -32419 (5)
13 -5 -32419 (6)
13 -5 -32419 (7)
13 -5 -32419 (8)
13 -5 -32419 (9)
13 -5 -32419 (10)