OPHTE# ~I- Y-- aa.X-~? Harnett County Department of Public Health 21121
PERMIT # Sa, 9 / Operation Permit
New Installation L~' )eP lcc Tank 11 Repair ~NltrlfCatlon Line ❑ Expansion
PROPERTY LOCATION: t~) ill 4 Q-'- . 414
Name: (owner) S,*sQn `~L. 6:1a. SUBDIVISION CSt-fo^ cr, .T~sr~r LOT # ~7/_
System Installer: -7:~j Registration #
Basement with plumbing: ❑ Garage 0~Number of Bedrooms _ 13
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 77T C- Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
MIS 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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V III 111 VV11 11V 111.
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 sewag~AIsposall system on the above c ptioned property.
Type of system: ❑ Conventional 2' Other c.~1y. M .-Ad- d-- Septic Tank: 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch U feet ditches 3 feet ditches J~ 2-Z
inches
French Drain Required: Linear feet
Authorized State Agent, Date Z c"/ (11
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