OPHTE# ,o-~ - z&sz~ Harnett County Department of Public Health 21 0 2 7
PERMIT # Z 5-711 Operation Permit
5~ New Installation 9 Septic Tank ❑ Repair e Nitrification Line ❑ Expansion
PROPERTY LOCATION: s,r zcnc- cr,4-g, pviQQ. 1q)
Name: (owner) DoNAT-c Lⅈ ; ~•ut^ SUBDIVISION LOT #
System Installer Registration #
Basement with plumbing: ❑ Garage J Number of Bedrooms
Type of Water Supply: ❑ Community lJ Public Well Distance from well LW • feet
System Type: G'5 ~i~lt. 7y~ C-4A AZTypes 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.
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DCDMIT Mkini Mr.
1. Performance:
11. Monitoring:
111. 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 disposal system on the above captioned property.
Type of system: ❑ Conventional 21 Other Zs 06 jF6 l?t,crsth-_ L'h0-&-4 Septic Tank: / 2 00 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 90 feet ditches feet ditches -2Y_ inches
French Drain Required: Linear feet
Authorized State
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