OPHTE# 13 -s �C) s�7,15 Harnett County Department of Public Health
PERMIT # 2 7(- .Z? Operation Permit 22967
Lt' New 'Installation 2�Septic Tank RrNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) /�� rti� f� C�,� .1f� C/�n d�.� Q&ekA- AUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public ELKWell Distance from well 00 feet
System Type: ZZG 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
rtnnrl LUNUMUNS:
I. 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 Er
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal system on the /above captioned property.
Type of system: ❑ Conventional 59 Other (S)u ec.k q Septic Tank: �SS"O gallons Pump Tank: gallons
Subsurface No. of exact length � width of depth of
>7
Drainage Field ditches of each ditch 00 feet ditches 3_ feet ditches inches
French Drain Required: Linear feet
Authorized State Agent &�,,_��o�- �' % Date /// 9 /Z a/--?
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rtnnrl LUNUMUNS:
I. 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 Er
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal system on the /above captioned property.
Type of system: ❑ Conventional 59 Other (S)u ec.k q Septic Tank: �SS"O gallons Pump Tank: gallons
Subsurface No. of exact length � width of depth of
>7
Drainage Field ditches of each ditch 00 feet ditches 3_ feet ditches inches
French Drain Required: Linear feet
Authorized State Agent &�,,_��o�- �' % Date /// 9 /Z a/--?
/.3 - s, 3 os';-8