OPHTE# 09-~:)aNS I Harnett County Department of Public Health 2 0 7 9 9
PERMIT # r~-S-L-1C1q Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: `-P'It.n¢,
Name: (owner) 5 NM v Et- ~oocsw ti~ SUBDIVISION ~--7 E ~A o t P6 LOT # 413
System Installer n Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _ 3
Type of Water Supply: L1 Community K Public ❑ Well Distance from well I CEO feet
System Type: 'mac 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.
tens system na3 Deen mstaneo in
with applicable north Larouna beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
SysrGn.
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Permit and Construction Authorization.
1 L111111 l.Vl\VII IV I\J.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nkx
If yes, see attached sheet for additional operation ct
maintenance and reporting.
V. Other. V-\ LL PLACED O c; 92.NaR %d \ ya 41AL3-P"r1 ° ^J
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other 'Q**- E-2 S w Septic Tank: 10 00 gallons Pump Tank:
Subsurface No. f exact length width of depth of
Drainage Field ditches 4 of each ditch t O 0 feet ditches 3 feet ditches a
French Drain Required: . ~utear Tlwt
_ gallons
Bbio",
inches NRSUaar,
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Authorized State Agent 'V'-`- R-:5 - Date 1~ I a(-I
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