OPHTE#Zd-s"-23-775- Harnett County Department of Public Health 20912
PERMIT # ZS"7 Z o Operation Pe itlt
❑ New Installation li Septic Tank ❑ Repair ❑ Nitrification 2~
cation Line L~ Expansion
PROPERTY LOCATION: <e j77s-- L2 'c,,,,. a 42-
Name: (owner) 5,7ye-K~-' 2! SUBDIVISION "'/co,..~, U,~3 yi( LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Z ber ofBedlr m /-~y
Type of Water Supply: El Community L~7 Public 2 "Well Distance from well feet
System Type: 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.
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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other Septic Tank 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of Drainage Field ditches 6, of each ditch feet ditches X feet ditches inches
French Drain Required: Linear feet
Authorized State Age ~G
Date -3