OPHTE# //-s =2.k-( 1 Harnett County Department of Public Health
PERMIT r Operation Permit 21 8 41
12'New Installation 2"-Septic Tank 0-Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: '7-;,i..e, fd,
Name: (owner) J&l1 C 1"k W..^e/- SUBDIVISION A.44 &,-i, LOT #
System Installer: =..ra'4%~.- Registration #
Basement with plumbing: ❑ Garage E21 Number of Bedrooms q
Type of Water Supply: ❑ Community 12"'Public ❑ Well Distance from well feet
System Type: G_ 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.
Ihis 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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HUM IUNUIIIUN):
1. 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 E2 ^
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the seewwap disposal system on the bove captioned property.
Type of system: ❑ Conventional L~' Other Q C_k 4C tc,t - Septic Tank: w3 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /oZ feet ditches feet ditches Zy -70 inches
French Drain Required: Linear feet
Authorized State Agen &I- ~ f( Date