OPHTE#Harnett County Department of Public Health
PERMIT Operation Permit 21 8 3 8
New Installation LEI"er Septic Tank ?,"Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /~'l " r- m meter
Name: (owner) ke-Ae-~k SUBDIVISION -7--k e 5-,, LOT # d~ d
System Installer:13 - Registration #
Basement with plumbing: ❑ Garage I' Number of Bedrooms -7
Type of Water Supply: ❑ Community [Public ❑ Well Distance from well feet
System Type: -Im ea 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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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 sewage disposal stem onI~he above captioned property.
Type of system: ❑ Conventional ❑ Other I Z.. F/a uj Septic Tank: /QC3 C
Subsurface No. of exact length width of
Drainage Field ditches of each ditch / 1/0 feet ditches
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches o2 inches
French Drain Required: Linear feet
Authorized State Agen Date '5-117
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