OPHTE# o/ X) Y11 Harnett County Department of Public Health
PERMIT # a l'- -7 Operation Pemit 2 21 5 2
o'New Installation Z' Septic Tank d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: yJ % It Lo c~ r Rd~.
Name: (owner) c. Co&.rl s u' ur. SUBDIVISIONS e--t LOT # q
System Installer: A'h A "9vi-'A'C~"Ic- Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms _ 3
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: TfZ-3 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 rnunrrinijC•
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑
Following are the Ifications for the sewage disposal system on the above captioned property.
Type of syste sp
m: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch J00 feet
H2OLine ❑
Septic Tank: /6G0 gallons Pump Tank:
width of depth of
ditches 3 feet ditches
PWR Line
gallons
inches
French Drain Required: Linear feet
/ 17
Authorized State Agen Date f,Z /
Alarm ❑
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