OPHTE# d~-5"- 21831 Harnett County Department of Public Health 2 0 4 5 5
PERMIT # Z 7- 39 ZOperation Pe ltl
New Installation L~J Septic Tank ❑ Repair 1~1 Nitrification Line ❑ Exnancinn
PROPERTY LOCATION:S,c ,
Name: (owner) l4~,3e 1d J,,%
SUBDIVISION LOT #
System Installer: X%,16v Registration #
Basement with plumbing: ❑ Garage E/Number of Bedrooms 3
Type of Water Supply: ❑ Community 7 Public ❑ Well Distance from well feet
System Type: Ls 7- G 6~L Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must ontact Health Department 6 months prior to expiration for permit renewal.
ims system nas oeen mstanea in compuame with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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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 specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other'DL~ Septic Tank: ! o0 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 1Or7 feet ditches feet ditches 1 y~ inches
trench Drain Required: Linear feet
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Authorized State Age ,a--- Date 5--;2L -69
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