OPHTE#/ -ZS-31 a Harnett County Department of Public Health
PERMIT # 7iagZcil Operation Permit 2 2 2 8 4
❑ New Installation ❑ Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t7z-3 /ZD
Name: (owner) /Su.C t-C,t SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Z" Public ❑ Well Distance from well feet
System Type: L~' 7 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_ been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
PERMIT CONDITIONS:
1. Performance: Syste shall perform in accordance with Rule .19J.
11. Monitoring: As re uired by Rule .1961.
III. Maintenance: As re uired by Rule .1961. Other:
Subs ace system operator required? Yes ❑ No ❑
If ye see attached sheet for additional operation conditions, mai/'nance and reporting.
IV. Operation:
V. Other:
Permit and Construction Authorization.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
following are the specifications for the sews,&a disposal system on the above captioned property.
Type of system: ❑ Conventional Z' Other`s A Septic Tank: J0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 140 feet ditches feet ditches 1 inches
French Drain Required: Linear feet
Authorized State Ag Date w 1 d t "