OPHTE#N-S00- DO 911 Harnett County Department of Public Health 2 0 7 6 9
PERMIT # `i Operation Permit
c7f~-New Installation ctl--Septic Tank ❑ Repair 19,,Nitrification Line ❑ Expansion
Name: (owner) 2(k
System Installer: ~t h l ty'
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Sup# ❑ Community `,V Public ❑ Well
System Type: s`-o T. Z IF 13
(In accordance with Table V a)
PROPERTY LOCATION:
SUBDIVISION (N v,\ b E LOT # \f r_
Registration #
Distance from well `feet
V-Z k-3 Types V and VI Systems expire in 5 years.
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 rMITIM-
Performance: System shall perform in accordance with Rule .1961
Monitoring. As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No b
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other h ✓ Septic Tank: O '->D gallons Pump Tank `J gallons
Subsurface No. of exact length width of depth of II
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: Linear feet
I Authorized State Agent Date D ~ I M •
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