OPHTE#_1 Harnett County Department of Public Health 9 � 7
f
PERMIT Operation Permit
New Installation Septic Tank`/ Nitrification Line 1:1 Repair ElExpansior
PROPERTY LOCATION: KPp,,2
Name: (owner) Ut4,o.4 Qrt 1 7eP Lbw . Q� SUBDIVISION LOT #
System Installer: C ,,l Registration #
Basement with plumbing: ❑ Garage ❑ Number of Q,5O 1 iAz.
Type of Water Supply: ❑ Community XPublic El Well Distance from well �eet
System Type: T"Si 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
is P. LL.
® (Z4-1
P
Nv �
rt:Rrnt t.unuuwnz
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 cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system 4p the above captioned property.
Type of system: ❑ Conventional Other . 2,V LC N Septic Tank: O gallons Pump Tank: d gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 50 feet ditches feet ditches_ inches
French Drain Required: °®_ Linear feet
11 Authorized State Agent P, . V Date R i,.W 115 11
� � ���� t��`�j�,.�t