OPHTE#C',f ~-s-~~D3g Harnett County Department of Public Health
PERMIT # X73 Operation Permit 21 61 3
I New Installation X Septic Tank ~ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 't~G'~
Name: (owner) W as N~ ~zyc.-nor SUBDIVISION I ,r-s cEN dN ~ LOT # G 'I-,_
System Installer. RP,4y-4 ga,~F,t~1 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well lba feet
System Type: ~~'I]s 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.
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 rANnlTInmc.
I. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .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.
N d VT s L- -%'11 E-5
l oas~ 5 Ei-j 1.., Q-Co CL or-1~kuvsE
❑
D-Box ❑
Pump ❑ Alarm
❑ 1-1201-ine ❑ PWR Line
Following are the spec
ifications for the sewage disp
osal system on the above captioned erty.
Type of system: ❑
Conventional X Other
C-NAyh r$EKL (,Qv~c c
Septic Tank: Vd~ gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage field
ditc S _
of each ditch t SO feet
ditches 3 feet ditches inches
French Drain Reauired:
.
I ina9Afnuf
Authorized State Agent ~~\e'&'05 Date 9l--~Lltd