OPHTE# o 9-s - aaa66 Harnett County Department of Public Health 2 0 7 0 3
PERMIT # R5-3 '-I Operation Permit
is New Installation ffF Se tic Tank ❑ Repair Iitrification Line ❑ Expansion
PROPERTY LOCATION: v~QO\ a.,. k-4
Name: (owner) Z-A.-TckhsN,, Ca~s,E SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage El'-Number of Bedrooms N
Type of Water Supply: ❑ Community E7 Public ❑ Well Distance from well feet
System Type: zr 14 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.
ImT Srsrem nas peen mstaneo in compliance with
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 e-
lf yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the s_peci~tions for the sewage disposal system on the above captioned property.
Type of system: e Conventional El Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of j
Drainage field ditches of each ditch d feet ditches '3 feet ditches 7 inrhec
French Drain Required:
linear feet
Authorized State Age
A- -
Date 17:9
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