OPHTE# 01- S-00- ~A-3k Harnett County Department of Public Health 2 0 9 7 4
PERMIT # ~ I Operation Permit
.New Installation [-Septic Tank ❑ Repair f Z Nitrification Line ❑ Expansion
PROPERTY LOCATION: { Z F
Name: (owner) 0 )A SUBDIVISION 2c~ 7 3 /1 kJ LOT # I- 3V
System Installer 6, ( /l t (k Registration #
Basement with plumbing: ❑ Garage Z Number of Bedrooms --T
Type of Water Supply: ❑ Community EK Public ❑ Well Distance from well 1 O ,3 feet
System Type: C 7 rka s T9 4 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 nas peen mstauen in compliance wim appncaDle north Larohna beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
If. 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 lK
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 1!6'Other 6.2 F\-J-j
Subsurface No. of exact length
Drainage Field ditches of each ditch ~n~ feet
Septic Tank: D gallons Pump Tank gallons
width of depth of
ditches _ feet ditches I ~ '4 A inches
French Drain Required: Linear feet
Authorized State Agent S Date ~b
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