OPHTE# 09 -s-- ZJ-7s-q Harnett County Department of Public Health 2 0 4 4 0
PERMIT # Zrr 3 3 Operation Permit
❑ New Installation ❑ Septic Tank ❑ Repair ❑ Nitrification Line C7 Expansion
PROPERTY LOCATION:-,c_
Name: (owner)f SUBDIVISION Gf LOT
System Installer. B68 rn~rn f f Registration #
Basement with plumbing: ❑ Garage V/Number/of Bedrooms
Type of Water Supply: ❑ Community EV Public ❑ Well Distance from well feet
System Type:? > v P~..3n P 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.
tms syscem has been mstaneo in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and
y-1'~
~1 b A
/+7- i z.~.~.
IZc;cordMe~{w~.~
6 0,:f ~t~olj
-Px-Jr►- / P-.4Y
q- 3-D*,-7 .
I r~c~ T ss~,~....
r.nrnr %.vnuurvna.
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the sp (cations for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
and all conditions of the Improvement Permit and Construction Authorization.
Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches feet ditches 'cy inches
trench Drain Required: Linear feet y~/J
Authorized State Age t / Date cf - 3 -d
♦
µ
s
r
jkl,
"
"
~C
♦
Y -R
_
'FAT
I
~,G."
v .
y
a
,.gyp ~ o
'
r
TA
s
r
♦
z t
ka
♦
v y
s
tim
,a -gym
rY.