OPHTE# ' /0Harnett County Department of Public Health 21279
PERMIT # 7 Operation Permit
Ltd' New Installation U/ Septic Tank ❑ Repair ET/ Nitrification Line ❑ Expansion
PROPERTY LOCATION: ;
Name: (owner) ke-Ancgl Cj M'W'-t_4 SUBDIVISION LOT #
System Installer: CS`f' s J-t~:c rC[~ mod` Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ 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.
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.
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.
Following are the specifications for the sew a disposal system on e above captioned property.
Type of system: ❑ Conventional ~ _ Other , vs Septic Tank: / L gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches C~ of each ditch 13 feet ditches feet ditches _I_'(inches
French Drain Required: linear feet
Authorized State AgentJ~ ~C' Date l~ ~~t~j