OPHTE# 1j 5 -3a b Harnett County Department of Public Health 23162
PERMIT # 7 �?� OlDeration Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C.'�oy 1nw
Name: (owner) Vz.'N`► SUBDIVISION = czS�,.� C�io�n r, QAt LOT #
System Installer: '—) � -T %>a-9 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well feet
System Type: _ \� 1 u 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.
tms system has Deen installed in compliance with applicable North Carolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
rtKMIl LUNUII UNY
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
(Z' Vi M � V�' N L—VN
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Ng,
If yes, see attached sheet for additional operation c(
maintenance and reporting.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑ Conventional Other t 2.E. C>N-, n5 Septic Tank: 1000) gallons Pump Tank: gallons
Subsurface No. exact length width of depth of
Drainage Field ditches ach ditch `2 O feet ditches feet ditches -3C) inches
French Drain Reauire _ lined
Authorized State Agent. - Date