OPHTE# \O~5 a~ao2 Harnett County Department of Public Health
PERMIT # a ~a❑3 Operation Permit 21 8 8 3
New Installation '4 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L-aSaTcL
Name: (owner) Vs-,N vA '90 u'--tio Glc '?::,u ~ a-06Ls SUBDIVISION \,3r4-,,,3T LOT # L5
System Installer: P oL,c Registration #
Basement with plumbing: ❑ Garage 'R Number of Bedrooms f j
Type of Water Supply: ❑ Community 12', Public ❑ Well Distance from well kt(0 feet
System Type: 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 l.arolma beneral Statutes, Rules for Sewage treatment and omsposal, and all conditions of the improvement rermit and t.onstruction nutnoraation.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventi Other GZL oyf Septic Tank: t gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 6 ea ditch feet ditches 3 feet ditches inches
linea
French Drain Reouired:
Authorized State Agent N \y' Date a h
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