OP RHTE#Harnett County Department of Public Health
PERMIT # Operation PPermi 2 2 0 0 5
EP New Installation L9"leptic Tank E~ Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATIOA:_~. T~ Ak
Name: (owner) SUBDIVISION LOT # I
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community [ Public ❑ Well Distance from well /0 J 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
Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
11. 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
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 seewwajrdisposal system on t above captioned property.
Type of system: ❑ Conventional Lid' Other C2 ~/Iia' Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 01, of each ditch feet ditches feet ditches d -76 inches
French Drain Required: Linear feet
Authorized State Agent{~ Date 61,701
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