OPHTE# IS - 3053 Harnett County Department of Public Health 23896
PERMIT # % 6GG9 w Operation Permit
C7 New Installation C]' Septic Tank Nitrification Line ❑ Repair ❑ ExpansioD
PROPERTY LOCATION:/if lvsv el" iz--a.'d� Fb
Name: (owner) j Li 2v -A, lk.-, Ta)CG SUBDIVISION LOT #
System Installer: Vt r e� 05v— , Registration #
Basement with plumbing: ❑ Garage LY Number of Bedrooms
Type of Water Supply: ❑ Community 1Z Public ❑ Well Distance from well feet
System Type: EL� Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General statures, Rules for Sewgke [read(nt and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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: ❑ Conventional sew
7,5%6 17£br/G'Yi/7-A) Septic Tank: i c O 0 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 5 of each ditch t 0 V feet ditches 3 feet ditches Z " -" s g inches
French Drain Required: rUmear feet
Authorized State Ageld-_-- C a f/ 7 �__� Date
15-5-36339 (1)
15-5-36339 (2)
15-5-36339 (3)
15-5-36339 (4)
15-5-36339 (5)
15-5-36339 (6)
15-5-36339 (7)
15-5-36339 (11) 15-5-36339 (12)
15-5-36339 (8)
15-5-36339 (9)
15-5-36339 (10)