OPHTE# /375 =3z /10
Harnett
County Department of Public Health
PERMIT # Z75 ?
Operation Permit
22999
Z/New Installation Septic Tank 2 Nitrification Line ❑
Repair ❑ Expansion
PROPERTY LOCATION:
`
Name: (owner) (fo,L�
SUBDIVISION G'
LOT #
System Installer:
f L
_ Registration #
Basement with plumbing: ❑
Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑
Well Distance from well feet
System Type: 10
21 Types V and VI Systems expire in 5 years.
V
(In accordance with fable V a)
7A A"*f;ir a
y wner 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.
o,
.a-0 5Iti
`
���
fit
Z
(fir ��• �
Elt
V
PERMIT CONDITIONS:
I. Performance:
Il. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned propert .
Type of system: El Conventional Other Z5-/& Z-1—' U Septic Tank: vU gallons Pump Tank: /dock gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 5 feet ditches inches
French Drain Required: Linear feet
Authorized State Agen Date /2— -3 _ i
13 -5 -32110 (1)
13 -5 -32110 (2)
13 -5 -32110 (3)
13 -5 -32110 (4)
13 -5 -32110 (5)
13 -5 -32110 (6)
13 -5 -32110 (7)
13 -5 -32110 (8)
13 -5 -32110 (9)
13 -5 -32110 (10)