OPHTE# z2-) Harnett County Department of Public Health
PERMIT # /Operation Permit 2 2 0 6 8
L' New Installation LJ` Septic Tank /Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION-,s_wLz4'3-7 0 . 40
Name: (owner) t5 SUBDIVISION / Pi LOT #
System Installer: 57 e j t Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Well Distance from well feet
System Type: Lin
L4wt 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
rEtsrut wtrunwns:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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
❑ Pump ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the specifications for
the sews a disposal system on the above captioned property.
(
Type of system:
❑ Conventional
Other 25'h g4h 1 Septic Tank: I DOD gallons Pump Tank: gallons
Subsurface
No. of
exact length F
width of depth of
Drainage Field
ditches
of each ditch feet
ditches -3 feet ditches 7- 2' 2 inches
French Drain Required: Linear feet
Authorized State A t
Date 7 3 6 A
462 2
E.
5 = Z~~ Z z 7
11-5-26227 (2) 11-5-26227 (3) 11-5-26227 (4)
11-5-26227 (7)