OPHTE# CD9-r-'IC VA Harnett County Department of Public Health 2 0 4 6 0
PERMIT # LSt Z7 Operation Permit
Q New Installation Septic Tank ❑ Repair /Witrification Line ❑ Expansion
PROPERTY LOCATION: izld
Name: (owner) CtJ L-3 CD'73-7A!5~dxs SUBDIVISION 6L, 6 16-13 0 LOT # 13
System Installer: 14~CbY1~ &r, yzftrc,;~ Registration #
Basement with plumbing: ❑ Garage ❑ k6ber of Bedrooms
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: S`d/b T tII" G f't Types V and V Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Departent 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North 4rolina General Statutes, Rules for Sewage Treatment and
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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.
IV. Operation:
V. Other
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Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other 15% sVcj) Septic Tank: / o o y gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch /0 o feet ditches 3 feet ditches t 5e, inrhoc
rent rain Required: linear feet
Authorized State A o
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