OPHTE# /!, -! = 3(0 s Harnett County Department of Public Health
PERMIT # !Z-731� Operation Permit 22995
Q New Installation D"Septic Tank E� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: F2L/y3-7
Name: (owner) 74o c- SUBDIVISION Ao-&� t2n2�� s LOT # I s`a
System Installer: '7`�2 f3 n v �-,J Registration #
Basement with plumbing: ❑ Garage �*Inber of Bedrooms
Type of Water Supply: El Community Public ❑ Well Distance from well feet
System Type: 16 7,M Z A ors 6L, &�r� &C,,*- ,j Types V and VI Systems expire in 5 years.
(In accordance with able V a) 'rY/l� X 3 Owner must contact Health Department 6 months prior to expiration for permit renewal.
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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
_90 I1I 1111mini,cI
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: El entional Conv Other ZS" /- r?-+by -cam . Q,.%',"�`"a'�eptic Tank: j �b O gallons Pump Tank: t� °y gallons
Subsurface No. of exact length !_VM width of depth of
Drainage Field ditches of each ditch 5'0 - c/y feet ditches 3 feet ditches ' inches
French Drain Required: Linear feet
Authorized State Age Z ��� Date 3 '" i
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FR
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13 -5 -31059 (21)
13 -5 -31059 (22)
13 -5 -31059 (23)
13 -5 -31059 (24)
13 -5 -31059 (25)