OPHTE# y9-s - 21880 Harnett County Department of Public Health 2 0 6 8 0
PERMIT # ac s'z~-1 Operation Permit
LR New Installation lr .Septic Tank ❑ Repair ETINitri6cation Line ❑ Expansion
PROPERTY LOCATION: 7'r
Name: (owner) 31 ~ Cxr k /Jg ~ SUBDIVISION LOT # 13
System Installer m Registration #
Basement with plumbing ❑ Garage Number of Bedrooms ,3
Type of Water Supply: ❑ Community Z" Public ❑ Well Distance from well feet
System Type: j 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.
Inh spstem US peen mnanea m compuance with
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PERMIT CONDITIONS:
North larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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i. renunuautx. srueni snan penorm in accoroance witn NUle .1901.
II. Monitoring: As required by Rule .1961.
111. 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.
IV. Operation:
V. Other.
Following are the ssppecifi~ions for the sewage disposal system on the above captioned property.
Type of system: E;''Conventional ❑ Other
Subsurface No, of exact length
Drainage field ditches of each ditch 60 feet
Septic Tank: [gallons Pump Tank: gallons
width of depth of
ditches 2 feet ditches inches
French Dram Required: Linear feet
[Authorized State Agen c - Date Co & 2C"'
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