OPHTE# D7 - r-1916 Z- Harnett County Department of Public Health 19845
PERMIT # 2yz Z z ODeration Permit
L~ New Installation "ptic Tank ❑ Repair Z" Nitrification Line ❑ Expansion
PROPERTY LOCATIOkstl4w Z ,)s t ne t _
Name: (owner) N. C. /-"v-sr ~fmw~ 5 SUBDIVISION I -r., # b
System Installer. .J~~~ ~y1 Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms p
Type of Water Supply: ❑ Community GKPubhc El Well Distance from well feet
System Type: 2j',I& U-00cTPcv-,) Y41-A Ta ptZ' G 6z`'}7 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.
ttus system has dcm instal d m compkance with applicable North Carolina General Statutes, Rugs for Serge Treatment aad Disposal, and an (w4tiom of the Improvement Permit and (omtrucuon Audw6zatiom
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1. Performance:
II. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. 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 sews disposal system on the above captioned property.
Type of system: ❑ Conventional 3 Other l5 %rZ+~DyG~llnJ Size of tank: Septic Tank: _ Z&06 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch 100 feet ditches j feet ditches 30 I9 inches
French Drain Required: linear feet
Authorized State A0nt Za;R ,,A,4,z `n Date ' 2 S- d 8