OPHTE# k Harnett County Department of Public Health
PERMIT # 3 Operation Permit 21 9 H 7
New Installation N Septic TankX Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M I ° f &
Name: (owner) tam 66LL?--n 6D SUBDIVISION _ N Gah' r_r.c,-- LOT # A-3>-
System Installer: i EQ N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 14 0 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above, ca tione roperty.
Type of system: ❑ Conventional Other C-)1R,ttli~- -LN: Septic Tank: v OCO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 ach ditch `a~XJ feet ditches -3 feet ditches inches
french Drain Required: 1\ ~ Kfeet_ ~LLO`'t 'mN C
Authorized State Agent UA-16 Date
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