OPHTE# Harnett County Department of Public Health
PERMIT Operation Per-m-it 2 2 0 2 0
Cf New Installation 2' Septic Tank P Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /yI ci.,~ K1'
Name: (owner) nn SUBDIVISION LOT #
System Installer: o ?/,,k'L Registration #
Basement with plumbing: ❑ Garage ~ Number of Bedrooms S
Type of Water Supply: ❑ Community lid Public ❑ Well Distance from well feet
System Type: oTL 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.
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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rtKMII LUNVIIIUM:
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Following are th
e specifications for the
Type of system:
❑ Conventional
Subsurface
No. of
Drainage Field
ditches 13
Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sew a disposal system on he above captioned property.
Other ~Z~-t,J Septic Tank: 600 gallons Pump Tank: gallons
exact length width of depth of
of each ditch 7J- feet ditches 3 feet ditches 3 d - 163 inches
French Drain Required: Linear feet
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Authorized State Agent . c~v Date
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