OPHTE# f `' - �5 - Harnett County Department of Public Health
PERMIT # z 7JO c, Operation Permit 23015
❑ New Installation ❑ Septic Tank ❑ Nitrification Line ❑ Repair Expansion
_ PROPERTY LOCATION: /yet g 1, 5.Z�
Name: (owner) 1 17,.0 #—A� SUBDIVISION V 14. LOT # J80
System Installer: "`� �t Registration #
Basement with plumbing: ❑ Age ber of Bedrooms 3
Type of Water Supply: ❑ Community F,r Public ❑ Well Distance from well feet
System Type: "' iN)U 1„3 i s FZ 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.
tors system nas peen instauea in compuance with appucaoie Norm cargtma uenerat statutes, nines for Sewage treatment and msposai, and au conditions or the
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PERM11 LUNDIIIUNS:
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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
Alarm ❑
Septic Tank:
width of
ditches
rermrt and Lon$truCtlon Authorization.
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
French Drain Required: Linear feet
Authorized State Date IS : f 3 ° a
13- 5- 32512(1)
13 -5 -32512 (2)
13 -5 -32512 (3)
13 -5 -32512 (4)
13 -5 -32512 (5)
13 -5 -32512 (6)
13 -5 -32512 (7)
13 -5 -32512 (8)
13 -5 -32512 (9)
13 -5 -32512 (10)