OP RHTE#09-S--6*1g1Z Harnett County Department of Public Health 2 0 4 6 4
PERMIT # Zg6Y/ Operation P mit
New Installation L Septic Tank ❑ Repair /Nitrification Line ❑ Fxnansinn
Name: (owner) i.. /a .
System Installer: oirrs sr r~
Basement with plumbing: ❑ 6a4 E
Type of Water Supply: ❑ Community C
System Type: i✓'~~ j
(In accordance with Table V a)
PROPERTY LOCATION: ~iy3s'
' SUBDIVISION A) 141 LOT # J_
n lb,, #
number of Bedrooms _ 3
Public ❑ Well Distance from well feet
4-jZ: d -"6t- Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system has neen mstanea 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:
System shall perform in accordance with Role .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other.
Following are the specifications for the sew3,4 disposal system on the above captioned property.
Type of system: ❑ Conventional Other llZC-bVcri4r,) Septic Tank: I00U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches z of each ditch 1 Sy feet ditches 3 feet ditches -M- 2 q inches
french Drain Required: Linear feet
Authorized State Age Date 2 - 6 5
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