OPHTE# ,3- s -jagg1 Harnett County Department of Public Health 23086
PERMIT # o27��t y Operation Permit C2'New Installation [?"'Septic Tank C"'Nitrification Line ❑ Repair ❑ Expansion
/ /- PROPERTY LOCATION: . It Lycw,!' X6.
Name: (owner) &_ l ( C I c,r�f SUBDIVISION C,;,ra I; LOT # 2-
System Installer: Registration # .
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ..3
Type of Water Supply: ❑ Community VPublic ❑ Well Distance from well feet
System Type: G- 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.
ims system nas ueen ms(aueu in compuance wim appucame norm cartu na 1jenerat xatutes, ewes for )ewage treatment and uisposai, and an conditions of the
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PtHMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. 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.
Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
sew a disposal system on a �°ve cap oned property.
Other - - -c �"0.>ti Septic Tank: gallons Pump Tank: gallons
exact length width of depth of
of each ditch C) feet ditches 3 feet ditches y 7 inches
Linear feet
Authorized State Agent���y ` c �: , �� Date l y �2°
V. Other:
❑
D -Box 11
Following are the specifications for the
Type of system: El
Conventional
Subsurface
No. of
Drainage Field
ditches
French Drain Required:
Permit and Construction Authorization.
Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
sew a disposal system on a �°ve cap oned property.
Other - - -c �"0.>ti Septic Tank: gallons Pump Tank: gallons
exact length width of depth of
of each ditch C) feet ditches 3 feet ditches y 7 inches
Linear feet
Authorized State Agent���y ` c �: , �� Date l y �2°
%3 -S %3 z�l�ll