OP RRHTE#08s '-C' y7 z/Q Harnett County Department of Public Health 2 0 4 6 7
PERMIT # Zys 76:, Operation Permit
12/New Installation E Septic Tank ❑ Repair . Nitrification Line ❑ Expansion
PROPERTY LOCATION:-5t/ y 2-
Name: (owner) C' SUBDIVISION ~/z.~e.5 y- %z. LOT # lnt4
System Installer. Ta- a so Registration #
Basement with plumbing. ❑ Garage 2~"mber of Bedrooms 3
Type of Water Supply: ❑ Community ( Public ❑ Well Distance from well feet
System Type: Z5~'/o iZl~Atl~ ~Gtl>`1 / 7 cam) ~Z 40,11 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.
ims system nas peen mstauea to
rnm apphcahle north larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
Permit and Construction Authorization.
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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
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z5% ' g -iW ;7 !?5 /Y^;Z '~eptic Tank: 00b gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 36V feet ditches 3 feet ditches inches
French Drain Required: ~Linear feet
Authorized State A G- Date 7- -51-:0
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