OPHTE# v9-s-- 1190(- Harnett County Department of Public Health 2 0 6 7 5
PERMIT #Sys~ Operation -Pert
~ew Installation ET Septic Tank ❑ Repair e'litri6cation Line ❑ Expansion
PROPERTY LOCATION: ur~SQryt.
Name: (owner) 8 1 r-~ k ,a K 11 It d f c SUBDIVISION ~~a sl.. rc LOT # 4 6
System Installer Registration #
Basement with plumbing: ❑ Garage 2 Number of Bedrooms _ 3
Type of Water Supply: ❑ Community lik"Public ❑ Well Distance from well feet
System Type: A 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.
INS 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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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 V
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the spe (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
Septic Tank: - gallons Pump Tank: _
width of depth of
ditches feet ditches
_ gallons
inches
french Drain Required: Linear fee
Authorized State Age / Date 6 W04l
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