OPHTE# JN - s- 23S'834 Harnett County Department of Public Health 21 4 7 6
PERMIT # ash Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: tVkc/1 f20 /a,c~
Name: (owner) SUBDIVISION -F1 Yv/ c r- LOT # -7
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms .---3
Type of Water Supply: ❑ Community ~2 Public ❑ Well Distance from well F~ feet
System Type: C' Z F ) o w 11~7a Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 10 Owner must contact Health Department 6 months prior to expiration for permit renewal.
ibis 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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MMtT rA11n ITUL1(.
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 ❑ No
If yes, see attached sheet for additional operation/ conditions, maintenance and reporting.
IV. Operation:
V. Other
following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑ Conventional ~r- Other 2 r17~ s c~_ Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch feet ditches _ 3 feet ditches
P74" 3J inrhnc
French Drain Required: Linear feet
Authorized State Agent Date " l7z>