OPHTE# D9- 5_00- _ 09`S Harnett County Department of Public Health
PERMIT # a 5a f' 3 Operation Permit
20767
-0 New Installation 9 Septic Tank ❑ Repair 6~' Nitrification Line ❑ Expansion
PROPERTY LOCATION: S(Z
Name: (owner) -(Zl2e d c SUBDIVISION 1'I e k LOT W-27-
System Installer. faddy n A f", P" Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Su ply: ❑ Community ❑ Public ER Well Distance from well feet
System Type: 2Av<< C~ 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.
Ibis 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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PERMIT CONnfTIONC-
I. 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 ecifcations for the sewage disposal syst on the above captioned property.
Type of system: Conventional ❑ Other (Z Ave Septic Tank: LOO J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditrhPC
French Drain Required: Linear feet
:A:uhorized :St :eA en
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