OPHTE# O°1-~'Ja0 0 0 Harnett County Department of Public Health 2 0 7 9 3
PERMIT # Sa Operation Permit
New Installation X, Septic Tank D Repair Nitrification Line E Expansion
PROPERTY LOCATION: Tt .,pt_.c. Zr
Name: (owner) 1_..twg ~`>>TC_ti~ELt SUBDIVISION `t"l.-c<3Ar-L.t LOT #
System Installer. G eases ~.Q>_~ Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well `00 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.
ims system Us peen mstauen in compliance with applicable North tarolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NQ4
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. Supe>y L, NL A< U-DE& U D~j L
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other q U `'So F.Z'F,_0,,,,,, Septic Tank: tOOO gallons Pump Tank: V0d0 gallons
Subsurface No. of exact length width of 3 depth of
Drainage field ditches beach ditch s feet ditches feet ditches inches
French Drain Reauired: _ ~ fpot
Authorized State Agent L'5 Date 8
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