OP RRHTE# Harnett County Department of Public Health 20921
PERMIT # SD G Operation Permit
CJ~-New Installation Septic Tank ❑ Repair 1114U trification Line ❑ Expansion
PROPERTY LOCATION: / I-
Name: (owner) /I SUBDIVISION LOT # _
System Installer: Registration #
Basement with plumbing: ❑ Garage ~K Number of Bedrooms 3_
Type of Water Sumly: ❑ Community 9- Public ❑ Well Di a from well feet
System Type: _J-44! W 2S C~ u . e 4- 'Y ` ! 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.
1
y
1. Performance:
II. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sew disposal stem on the abo~captioned property.
Type of system: ❑ Conventional 16 Other Aft A Septic Tank: gallons Pump Tank: 00~) gallons
Subsurface No. of exact length width of r~ depth of
Drainage field ditches - of each ditch ~ feet ditches ) feet ditrhm 4 i-h-
rent ram egwre : Linear feet
Authorized State Agent 0
Date t U -1
r
~.t
.k
♦y
"
i
I
3
r y
F6
` J
L
A}f ~4~,4t
~ m
s
d
a
Wfl,
. 4,
M-J aa'A~ a-
&i'&d3 ,
M J amen
~ L
xf
^,x
yP
~Y
t
*f~
q
*RAW
fi
Yrf
t 3~
~
,
yt
te. ~i.k"'('
a
z
~
~
a
.f 1 Tf' +d3~..