OPHTE# ®-,5- a t.,38Y Harnett County Department of Public Health
PERMIT # a.6 4-5' Operation Permit 21 8 3 5
Q'New Installation R"' Septic Tank L" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: f ea,%G wog e •
Name: (owner) Tu„n4- c lcU `ny SUBDIVISION LOT #
System Installer: ~~=J~~ :c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 52" Public ❑ Well Distance from well feet
System Type: 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 Larolma beneral )tatutes, Rules for sewage Ireatment and Ulsposal, and all conditions of the
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rermlt and Lonstructlon Authorization.
PERMIT CONDITIONS:
1. 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 ❑ Na
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other EZ- Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches 3 of each ditch f010) feet ditches
H20Line ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches /Q inches
French Drain Required: Linear feet
E ized State Age /as Date OC/
3 7 77
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