OPHTE# s- z-7gag Harnett County Department of Public Health
PERMIT # Z 1-7 7 Operation Permit 2 2 0 5 0
Q/' ( New Installation Lg' Septic Tank [`Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1-,d 'ele.
Name: (owner) K9- 2c Atr ~v. G"kra~ SUBDIVISION LOT #
System Installer: o f~ ;,r off /c ~~w4d Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -7
Type of Water Supply: ❑ Community Q/Public ❑ Well Distance from well feet
System Type: i`j 8 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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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:
Other:
V
.
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are th
e specifications for the sew~ge disposal system on the above cap toned property.
Type of system:
❑ Conventional 10 Other
P-e
Septic Tank: /ova gallons Pump Tank: /060 gallons
Subsurface
No. of
exact length
-
-
width of depth of
a `l
Drainage Field
ditches 02
feet
of each ditch
7 J
inches
ditches feet ditches
French Drain Required: Linear feet l
Authorized State Agent W~^- f~ Date / z
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7
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1
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1
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x