OPHTE# 09-6--.2,Z„17 Z Harnett County Department of Public Health 2 0 6 8 9
PERMIT # d r i"U- Operation Permit
P( New Installation Z Septic Tank ❑ Repair ~itri6cation line ❑ Expansion
PROPERTY LOCATIO : dcac,~ I1.
Name: (owner) ~ n n. C~n • cry SUBDIVISION i , oI LOT #
System Installer: %.,Ast V z,44---o Registration #
Basement with plumbing: ❑ Garage ❑ Nmber of Bedrooms
Type of Water Supply: ❑ Community I_? Public ❑ Well Distance from well feet
System Type: G- Types V and VI Systems expire in 5 years. 77F (In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This 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.
~ ~ t fh
`t 1
_z b
C'
c ~ 7e ~ C~1r
ornMtr ,nuntrtnuc.
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal s stem on the above cap ned pryperty.
Type of system: ❑ Conventional Other 43v' C k C a~.yc Septic Tank: Icrio gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches -f feet ditches inches
french Drain Required: Linear feet
Authorized State Agent 1--~ • / Date S~7 A-0
01
s ~
. r{ J
y, ~ ~ , ~v # ter`
x~ ~ t
1L' 4S
- ~ 'u. ;ate
fib` d 4 :
I~
..r
t
MA
l 3 k 1
4 e ~S