OPHTE# Harnett County Department of Public Health 21032
PERMIT # / Operation Permit
_ 1~ New Installation E Septic Tank ❑ Repair 1 Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~i r-it-y ,c4
Name: (owner)/rur,~OZ L SUBDIVISION lv.sR. ~1h { .z:, LOT # 6
System Installer. 7 KEN L Registration #
Basement with plumbingbin : ❑ Garage ❑ Number of Bedrooms 3 8
Type of Water Supply: ❑ Community L✓J Public ❑ Well Distance from well feet
System Type: 25°n ~Z4fi0 Fi. - T Tt~ 6' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) %Iwne r mus t c tact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North farolina Generattules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
X Z,IZ~Af1J AS fsr
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PERMIT CONDITIONS:
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 sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other ZS ease. Septic Tank: / 6& n gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch to feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agett Date S " l -lb
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