OPHTE# 13 -s-- 3195-Z Harnett County Department of Public Health
PERMIT # 2--7s7 z Operation Permit 22993
C3'—New Installation 2r Septic Tank (metrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: J-,7 .z-0
Name: (owner) (f0-4 OL4 90 C- SUBDIVISION /?1P�e�, >� �r�„�� _ LOT # 7
System Installer: flo 5se-0 rl—Y -c- Registration #
Basement with plumbing: ❑ Garage g�NAber of Bedrooms Type of Water Supply: El Community Public ❑ Well Distance from well feet
System Type: 4,,, 2 174bv c s A,:O Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Ow r 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
PERMIT CONDITIONS:
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 seewwn$e disposal system on the above captioned property.
Type of system: El Conventional ld Other :Z,, rZ47>,� Septic Tank: / 0-c z> gallons Pump Tank: e' gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z- of each ditch 12-- feet ditches 3 feet ditches 30418 inches
French Drain Required: Linear feet
Authorized State A C._ �' �"�� Date „