OPHTE# ~I- -a~y3 Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 6 6
New Installation L\ Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ; i c- Cu ra.., N `QP
Name: (owner) e=~G~E 1 1--11 G SUBDIVISION L u c-9,5 LOT #
System Installer: L!?stALj Sr) r z- #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t b feet
System Type: tzz~z 011 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 Carolma General Statutes, Rules for Sewage treatment ana uisposai, ana an commons of the improvement reran: ana construawn Hutnorizauon.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N0)9
If yes, see attached sheet for additional operation a
IV. Operation:
V. Other:
maintenance and reporting.
N C' S sue; aaw raj N EFo
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for th sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other -T \ W. \ e 5 Septic Tank: 10 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Q) feet ditches feet ditches inches
French Drain Reauired: _-ti arr-fe4_
Authorized State Agent i~ 1 Date
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