OPHTE# Harnett County Department of Public Health
PERMIT #SC~ Operation Permit 2 2 0 5 2
Imo' New Installation E?"Septic Tank Z/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION.. raj
Name: (owner) ' ~,ftOrk-f SUBDIVISION LOT # r
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community Lit' Public ❑ Well istaD nce from well feet
System Type: 019 4--13 16Types 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
PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
licaM nofth Carolina GenerTS
e
Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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 seewwa~ disposal system on the above captioned property.
Type of system: ❑ Conventional L f" Other ,r? .F 6 , Sep c Tank: 1&60 gallons Pump Tank: e f-0 gallons
Subsurface No. of exact length 1~ I/ widthlof depth of
Drainage Field ditches of each ditch feet ditches -5 feet ditches Z inches
French Drain Required: Linear feet
Authorized State A nt Date 7 - ZL, - ff
pit
-7. 7
11-5-26695 (1) 11-5-26695 (2) 11-5-26695 (3) 11-5-26695 (4) 11-5-26695 (5)