OPHTE# b Y - ~3eso Harnett County Department of PublK Health 21 16 5
PERMIT # ~z ss `I 0 eration Permit
Name: (owner) `~~f~ "c~.`-'~
System Installer:, >'A d y i h
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community P~"Public ❑ Well
System Type:
(In accordance with Table V a)
0" New Installation Septic Tank ❑ Repair Fr' Nitrification Line ❑ Expansion
PROPERTY LOCATIO,~:
SUBDIVISION LOT # 7
Registration #
755- Distance from well feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
system nas been ""'l'ed 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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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 e disposal system on t e abgve captioned property.
Type of system: ❑ Conventional (sd Other (1 r on C it 'I" r /
6~ Septic Tank: !0O() gallons Pump sank: allons
Subsurface No. of exact length width of g
depth of
Drainage Field ditches `of each ditch 9 G feet ditches feet ditches `ly
French Drain Required: inches
Authorized State Agent_ 9~t-1A S Date ;~5 10
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