OPHTE# /e.S -ZVI63 Harnett County Department of Public Health 21036
PERMIT # 25711 Operatl0n Pe mit
ENew Installation Septic Tank ❑ Repair 2 /Nitrification Line ❑ Exnansinn
PROPERTY LOCATION:--u- i wi 4"-.. E,.t 2a
Name: (owner) ~~i~~•c s SUBDIVISION Cekes~v,.,_ LOT #
System Installer: F ,w.•czl Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms .3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: a2f%A % ux G t~z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) rZ Owner mu contact Health Department 6 months prior to expiration for permit renewal.
Ihls 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:
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 sew a disposal system on the above captioned propel
Type of system: ❑ Conventional Other 7VIt,/Z(- 1cVio } ,1v;✓, - fs Z ~ Septic Tank: )/-)0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch bd feet ditches .3 feet ditches 2Y_ inches
French Drain Required: Linear feet
Authorized State Ag~ Date - '7 _ I
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