OP RHTE# CW-s- ZZao I4Z Harnett County Department of Public Health 2 0 8 9 7
PERMIT # 1-57 YZ, Operation- Permit
L~ New Installation Z Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:-/79o GS~cf~ F~az.~ tiS
Name: (owner) ~J SUBDIVISION LOT # Z-0_
System Installer: U is J;TRegistration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -3
Type of Water Supply: ❑ Community i' Public ❑ Well Distance from well feet
System Type: 259a IZwu~x.J T tA4, Zi& X G !!f3 Types V and V1 Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ihis 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:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other 15~1~/1y171)LZ"L/~ ~s s~6-s- Septic Tank: 1400 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches Z of each ditch /rb feet ditches 0 feet ditches ZO~ inches
French Drain Required: Linear feet
Authorized State Agen
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