OPHTE# W _ 2699'5- Harnett County Department of Public Health 2 0 4 3 3
PERMIT # 1_YRl Operation PeIt
U✓ New Installation 9 Septic Tank El Repair Nfication Line ❑ Expansion
_ PROPERTY LOCATION:.s2 lnp(n I)iD sm-w(~
Name: (owner) t74oej l SUBDIVISION LOT #
System Installer: y,?ie,r,~/ Registration #
Basement with plumbing: ❑ Garage ❑ Number ofBe°oms ..3
Type of Water Supply: El Community 11 Public 9 Well Distance from well / 06 ~ feet
System Type: Miuf 0'6 /7. b F?m £r. ~8. - Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owne "ust-wact-l4th 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:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other. IV. Operation:
V. Other.
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Following are the specifications for the sew a disposal system on the above captioned property. 4-
Type of system: El Conventional Other P4,o", i,:i 'S%/oV-6 -rw-- f-._. Septic Tank: 00 gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage field ditches Z. of each ditch 1~0 feet ditches _ feet ditches IY" I Q~~ inches
French Drain Required: Linear feet
Authorized State Age Date I -Z.3'U 7
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
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