OPHTE# ii - _31 -3(�G Harnett County Department of Public Health 23138
PERMIT # �.�5 Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: j 1,4 �4 to
Name: (owner) 9- P.i- Lyi c R,s SUBDIVISION a3 V,3i<N- LOT # -�
System Installer: —11--g -(L,-,t v-1 Registration #
Basement with plumbing: ❑ Garage �K Number of Bedrooms --'�>
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I<)C) feet
System Type: c, 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
rt:nrtn t.unuiiiuns:
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 �w
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box
❑ Pump ❑ Alarm ❑
1-12O1-ine ❑
Following are the specifications
for
the sewage disposal system on the above captioned property.
Type of system: El
Conventional
OtherAt�t?,� �Q�" Septic Tank: 1� ®6
gallons Pump Tank:
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
( of each ditch 19 O feet ditches 3
feet ditches
French Drain Required:
_ F
-- Linear feet
Authorized State Agent Date
-
2
PWR Line
gallons
inches
13� 5� 3 �3�-�