OPHTE#O`-r -Z~ Harnett County Department of Public Health 2 0 91 4
PERMIT # _ZS-7/57 Operation Permit
d New Installation L~ Septic Tank 2/Repair Z Nitrification Line ❑ Expansion
PROPERTY LOCATION:<2/.z5-6U 1&6
Name: (owner) ✓ SUBDIVISION A~,vwr ~y ol,u~,z LOT # Z_
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ ~llumber of Bedrooms . 3
Type of Water Supply: ❑ Community ~ Public ❑ Well Distance from well feet
System Type: ZS~6 _rsl~ ~yz~T'G c~ 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 Sewa e,T atment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewa;edisposal system on the above captioned property.
Type of system: ❑ Conventional Z Other 7S'' i7~Fr2t~critrn_ Septic Tank: /ocrO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch feet ditches j feet ditches 7 Yom) tg inches
French Drain Required: linear feet
Authorized State Age Date t!;-- -7 - / c7
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