OPHTE# Harnett County Department of Public Health 21280
PERMIT # 0 eration Per It
New Installation Septic Tank El Repair ET~Nltrlfication Line E Expansion
PROPERTY LO(ATION: ~ks4d.
Name: (owner) C~~~.~e. SUBDIVISION LOT #
System Installer: r<4_rb ..ti.~ _ Registration #
Basement with plumbing: ❑ Garage i ~mber of Bedrooms , _
Type of Water Supply: ❑ Community 2 public ❑ Well Distance from well feet
System Type: 7 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.
ims 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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PERMIT CONDITIONS: L a- Cc - ~
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No V
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other, i4.V k k",Ae cz~, a er C7lC 2 Ala / S W ~ , ~ ~ ~ ~e~l
Following are the specifications for the sewa disposal system op the abov caption ~jd property.
Type of system: ❑ Conventional Other ~=C k C~ CvM b!,, Septic Tank: gallons Pump Tank: gallons
Subsurface No. of / exact length width of depth of
Drainage Field ditches / of each ditch /20 feet ditches feet ditches inches
French Drain Required: _Linear feet
Authorized State Age 1'~ "1-1' -1Zir
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