OPHTE# o`1-5-MTM Harnett County Department of Public Health 2 0 5 6 6
PERMIT # 2.5y Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line 17 Expansion
PROPERTY LOCATION: P,o~ o~•~
Name: (owner) \IynK CoN 5-\ , L SUBDIVISION or~[ct gyp, LOT # _
System Installer. Cd 2Ey G \ L_g E L`~ Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms ___a
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well f b0 feet
System Type: 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.
I. Performance:
II. Monitoring:
III. 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 ❑ NOA
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: ❑ Conventional Other CWAsn~FtL Ng,, - \N\(> Septic Tank: 1004 gallons Pump Tank: gallons
Subsurface No. of exact length 14 PaN~.5 width of depth of
Drainage Field ditch Lt of each ditch `IO feet ditches feet ditches _ V% inches
French Drain Reauired:s~
I's
Authorized State Agent ~~b ToLf,;S- Date 5) (0