OPHTE#c~L9 LL ~51 3-~, Harnett County Department of Public Health 2 0 5 4 2
PERMIT # a:5 1-1> Operation Permit
I New Installation A Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ~)',AN>r. SUBDIVISION LOT #
System Installer: 5 'S; g,,,\c.x.t-c~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ~kl_
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well i00 feet
System Type: X1.1, Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
u Intl nay ueeu nn[aneu in
PERMIT rmmnlTUUla
(~~D
1. Performance:
11. Monitoring:
Ill. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Dq Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch C'j foot
Septic Tank: i C' r> gallons Pump Tank: gallons
width of depth of
French Drain Required inea t iccr suane~ 1 4 mcnes
Authorized State Agent ~ I C Date q
wrn appucaole North Larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.