OPHTE# I/-r = Harnett County Department of Public Health
PERMIT # ai.g71 ^,rOperation Permit 21 8 4 0
EE New Installation Ed~Septlc Tank 2~Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION:
Name: (owner) ifl C a SUBDIVISION ,2..++- A; 4~ LOT # 77
System Installer: } jg-e~; Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community VPublic ❑ Well Distance from well feet
System Type: 1ZT cl- 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
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other Q.~ r_k tt Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches of each ditch 60 feet ditches
H20Line ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches ` inches
French Drain Required: Linear feet
Authorized State Agent ~ Date