OPHTE# tom- - 3p,(-a 1 Harnett county Department of Public Health 23128
PERMIT # Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C —o Li �.1
Name: (owner) C) .gYx f - %C`Z- SUBDIVISION facli LOT # . LA_
System Installer: L�-c, -j >1s>,gR Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a
Type of Water Supply: ❑ Community -X Public ❑ Well Distance from well 100 feet
System Type: — cwl 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
rtKMII LUNIJI1IUNY
I. 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 ❑ Nox
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 �-5
Subsurface No. of exact length
Drainage Field ditches 1 of each ditch feet
French Drain Required: ear feet
Authorized State
Alarm ❑
Septic Tank: loco
width of
ditches
Date
H2OLine ❑
gallons Pump Tank:
depth of
feet ditches 12 —fit
im
PWR Line
gallons
inches