OPHTE# 11- \O'\ Harnett County Department of Public Health
PERMIT #Operation Permit 21 9 7 0
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: oct-~~
Name: (owner) SUBDIVISION 'Nsv, -osiP LOT # _
System Installer: lea Q» c~rr►~ Registration #
Basement with plumbing: El Garagei4 ] Number of Bedrooms 4
Type of Water Supply: ❑ Commune Public ❑ Well Distance from well 100 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.
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
~^o
D
rEnrni lvnutrtvns:
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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑
following are the specifications for the sewage disposal system on the abo a caplied property.
Type of system: ❑ Conventional `ti Other _ Septic Tank: \000 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches
French Drain Reauired: -c~.~ Lineal feet
PWR Line
gallons
inches
Authorized State Agent 7 ~ ,'5 Date \ I,
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