OP RRHTE#_0 2(7/-5 &F Harnett County Department of Public Health 2 0 8 8 6
PERMIT # z s/ 3 q Operation Pe
Z New Installation lJ Septic Tank ❑ Repair Z Nitrification Line ❑ Expansion
PROPERTY LOCATION:_~.c-~sY ,2/J
Name: (owner) SUBDIVISION T LOT #
System Installer.Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Z tZ hople h
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: -VIA ZgAxj)~m~ k- TLT' C. c4--Q- 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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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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other _5 to pPGp A= ~ Septic Tank: / La o gallons Pump Tank: allons
Subsurface No. of exact length width of g
Drainage field ditches 3 jj 3 depth of
of each ditch ~ feet ditches feet ditches Jb~ inches
French Drain Required: Linear feet
Authorized State Age Z A,1- Date Z- Z Z
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