OPHTE#CR -s_Zza:5(, Harnett County Department of Public Health 20871
PERMIT # z~y Operation Pit
New Installation M Septic Tank ❑ Repair EX/Nitriffcation Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 5r1--'t'h1fASOU AWdetn, v Y- SUBDIVISION a LOT # TA
System Installer: Registration #
Basement with plumbing. ❑ Garage lumber of Bedrooms _
Type of Water Supply: ❑ Community IQ Public ❑ Well Distance from well feet
System Type: 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.
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.
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1. Performance: System shall perform in accordance with Rule .1961.
11. 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 sew a disposal system on the above captioned property.
Type of system: 11 Conventional Other ZS/e "DOCTi4-,~ Septic Tank: f D 4) 0 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ~y d feet ditches feet ditches ib-1$ inches
French Drain Required: linear feet
1110
Authorized State Agent
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