OPHTE# 5'- Z-j'330 Harnett County Department of Public Health
PERMIT # Z&sZS° Operation Pe mit 1 22082
/New Installation L+~ Septic Tank /Nitrification Line ❑ Renair F] Fxnansinn
PROPERTY LOCATION: t-t63 Kj~~Jj CffVe_zP t2b
Name: (owner) Xjyy-y~ G _51SUBDIVISION 81 LOT #
System Installer: 7~~ Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 3
Type of Water Supply: ❑ Commum L Public ❑ Well Distance from well feet
System Type: 7504 . 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.
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1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewagcr disposal system on the above captioned property. g, 7-
Type of system: ❑ Conventional IX Other 6A* Z6- `z->:S Se tic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches Z 6 _19 inches
french Drain Required: Linear feet
Authorized State gent Date J) ° ZI - ti
41
11-5-27330 (11)
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11-5-27330 (11)