OPHTE#s)8 s -20%1 Harnett County --Department of Public Health
20432
PERMIT # z s I ~ ~ Operation Permit
New Installation 9 Septic Tank ❑ Repair Nitrification Line ❑ Exnansinn
PROPERTY LOCATION: -5-41-5q z d/ip dU C Z 2,)
Name: (owner) A- <S SUBDIVISION ~J Y G,zOt/.~' LOT # j
System Installer: ~p 0o6-,z Registration #
Basement with plumbing: ❑ Garage ❑ ,Number of Bedrooms 2
Type of Water Supply: ❑ Community 2 Public ❑ Well Distance from well feet
System Type: ZS 76 244 K~ s '1=t4" -M G CZc A- Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 11
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
Following are the specifications for the s disposal system on the above captioned property.
Type of system: El Conventional ewaOther Septic Tank: /00 Z> gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of each ditch -70 feet ditches Y feet ditches Z6 -
2%ches
French Drain Required: Linear feet
Authorized State Ag~t Date Z-17 -6~
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