OPHTE# O"7- s- 17-7'3 Harnett County Department of Public Health 2 0 4 3 4
PERMIT # 241016- Operation Perms
1Z New Installation Septic Tank ❑ Repair /wItrification Line ❑ Exnansinn
PROPERTY LOCATION:
Name: (owner) 2. f,i;i,, a- SUBDIVISION %s/<-k4 ~ LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage /Aumber of Bedrooms 3
Type of Water Supply: El Community & Public ❑ Well Distance from well feet
System Type: Z57% r ~~c JZQI~ .7~,i ~2>` TyT e Inc G J5%4" 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.
ma irsnem has Been muaueo in compuance wan appucaoie north tarolma heneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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
following are the specifications for the sewKe disposal system on the above captioned property
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Authorized State A>?e r~~~.~ / ~h~.
Type of system: ❑ Conventional Other ZS°h~ f vc tyvL Septic Tank: CrQ-0 gallons Pump Tank: gallons
Subsurface No. of exact length width of~ depth of
Drainage Field ditches of each ditch { D feet ditches feet ditches Z.1 -z 1 `b inches
French Drain Required: Linear feet
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