OPHTE# 09--5~:)O-R0,33z Harnett County Department of Public Health 2 0 9 7 7
PERMIT # Operation Permit
-flew Installation D4 Septic Tank ❑ Repair I Nitrification Line ❑ Expansion
PROPERTY LOCATION: S~Z \3 `3
Name: (owner) SUBDIVISION LOT # 3(--
System Installer: ~.c ~ fl
Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms- )
Type of Water Supply: immunity Public ❑ Well Distance from well - feet
System Type: 2t r~ Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
[his system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
t
t
C.t nd ~ C
t
PERMIT (ONI)1TIM.
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. 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~ygem on the above captioned property. 1
Type of system: ❑ Conventional Other - (1 Pl < Septic Tank: ' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of!
Drainage Field ditches of each ditch feet ditches 3 feet ditrhn< ( 1 q3 ineha,
French Drain Required: linear feet
Authorized State Agent Date
s
ti
! J r' F §
f :fir ~YY 4(
Y s« 4
Flo
_ it t
'Ilk
k n
.ter.
t ~ - s,
- t
t
y
k fi
.
- F k~.
in'r
y
^y w ~r
}
n 40 '
s
R_=
a
4
~r
~ . '
~
yy,~
Al
•rZ
_
A
e ~
1
P S
r
r 1~
r Y
-j4k .r t f 5t• - >
I y r i
S ~
Gr~~` r ~~«eti.• .
t 'toad of tir 'hips ~froa. the e! qc~q j
kti ~nnova ve Wdi1o r prs M.Oppro IMIVG$^ ~a to as
k