OPHTE# n-7 -s= ItaS%. Harnett County Department of Public Health 2 0 9 2 0
PERMIT # zygq d Operation Pe it
1New Installation I_ Septic Tank ❑ Repair /Nitrification Line ❑ Exoanctnn
PROPERTY LOCATION:,~Z &118 ~3'3c
Name: (owner) S;kIL SUBDIVISION _ LOT # S
System Installer: Registration #
Basement with plumbing: ❑ Garage Vpublic umber of Bedrooms ~
Type of Water Supply: ❑ Community ❑ Well Distance from well feet
System Type: S° Types Y 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.
nos system nas oeen mstanea in compuance with applicable North larohna 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 seww3ge disposal system on the above captioned property.
Type of system: ❑ Conventional Ltd Other ZS/o 1201) Septic Tank: JC*)O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch Z5~b feet ditches 3 feet dittlim /b .-)i9 inrhat
French rain Required: linear feet
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Authorized State Age t Date
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