OPHTE# a y-s=a-Z~~--7 Harnett County Department of Public Health 21 13 3
PERMIT # a-S- -7 0 eration Permit
New Installation I~-Ieptic Tank ❑ Repair E nitrification Line ❑ Expansion
PROPERTY LO(ATION: 9-? )-44
Name: (owner) v~cri a,~c{ H~~r SUBDIVISION ~c ~~t (►f~-~l cy LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage [?"-Number of Bedrooms
Type of Water Supply: ❑ Community E;-fublic ❑ Well Distance from well feet
System Type: 77L- S 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.
ims 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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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 2"-
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. i
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Following are the specifications for the seewwaa a spo system on the above captione ro rty.
Type of system: ❑ Conventional LI Other v rY~ - , QQ ; c k... I ~o A-4 Septic Tank: QG 0 gallons Pump Tank: 00 gallons
Subsurface No. of exact length width of depth of
Drainage field dltc e of each ditch 300 feet ditches 3 feet ditches inches
French Drain Reouired: _ar fnat
Authorized State Agent Nj,. x\15 Date 1\1 5
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