OPHTE# C(,-500-1 SAS I Harnett County Department of Public Health 21 4 7 4
PERMIT # 2 3Y1 Operation Permit
New Installation pK~eptic Tank ❑ Repairt2l Nitrification Line ❑ Expansion
P PROPERTY LOCATION: t
Name: (owner) SUBDIVISION G ► h .1 k S LOT # 33
System Installer. O. S i 2,z K 6 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J
Type of Water Sup ❑ Community Public ❑ Well Distance from well feet
System Type: ~ 2 f7 \'Zl~ 115/ 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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1. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal V stem on the above captioned property.
Type of system: ❑ Conventional -Other --Z F (-.)t ✓ Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 2-2- feet ditches -3 feet ditches = inches
French Drain Required: Linear feet
Authorized State
Date 5 - ~ - A01 -0
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