OPHTE# o~ s-aas~~ Harnett County Department of Public Health 21 2 4 6
PERMIT # 'D-65nO Operation Permit
New Installation 'S Septic Tank El Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: Nc_a1 w
Name: (owner) a, o pA-F- " Ho _ ~-c,. SUBDIVISION M,Q-g- &LC.Nc,~a LOT # ."I
System Installer: ~ ~.o ~ew~rr Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tOb feet
System Type: 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.
This 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:
If. 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 sewage disposal system on the above captioned prope
Type of system: ❑ Conventional )~k Other 9-4-~cb G~a.M~st_ uticK- Septic Tank: so00 gallons Pump Tank: th0C~ gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch Sd feet ditches 3 feet ditches A'--30 inches
French Drain Required: Lin feet
Authorized State Agent_ Date x
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