OPHTE# 12-5 —63 �� Harnett County Department of Public Health 23112
PERMIT # d=7(o 65J Operation Permit
ZNew Installation Er Septic Tank Er'-Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Q
Name: (owner) Kerr ne � :. �� SUBDIVISION LOT # / V7
System Installer: C4:s Registration #
Basement with plumbing: ❑ Garage ❑ mber of Bedrooms 3
Type of Water Supply: ❑ Community I Public ❑ Well Distance from well feet
System Type: ju 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.
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r[mrns wivuuiutr3:
I. Performance:
II. Monitoring:
III. 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 ❑
Following are the specifications for the sewad disposal system on the above captioned property.
Type of system: ❑ Conventional Other 6 Z
Subsurface No. of exact length
Drainage Field ditches �_ of each ditch /80 feet
French Drain Required: Linear feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: 10.)() gallons Pump Tank: gallons
width of depth of
ditches feet ditches '(8 inches
Authorized State Agent//-- = f,�� /� Date ' l -'J IROI
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