OP RHTE# 09- s°0- a i 0s2" Harnett County Department of Public Health 2 0 7 2 5
PERMIT # Operation Permit
New Installation Se tic Tank El Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: P( 7
Name: (owner) C,A~.r~~/ 1 , c C SUBDIVISION (z c ~7 L) n k j LOT # 2 j
System Installer: 0 C Cr~r Registration # 1-4
Basement with plumbing: ❑ Garage ~j Number of Bedrooms
Type of Water Suppl : ❑ Community 9 Public ❑ Well Distance from well 2 J feet
System Type: , 1~ ail 1 q 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.
IV. Operation:
V. Other.
Following are the specifications for the sew disposal systp on the above captioned property.
Type of system: ❑ Conventional ther ( , ~,A I C {'l L~ Septic Tank: ,DOD gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches ~ feet ditches d C) inches
French Drain Required: Linear feet
Authorized State Agent Date
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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