OPHTE# 01460 ;aWt, Harnett County Department of Public Health 2 0 9 7 3
PERMIT # Operation Permit
~ew InstallatioVTI optic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LO N:L
Name: (owner) } /'f f'JR~~ /7J
System Installer r~.1 i/L, t k q,.j SUBDIVISION 4- D a LOT #
Registration #
Basement with plumbing: ❑ Garage ,;R- Number of Bedrooms __'3
Type of Water Supply: ❑ Community ( Public ❑ Well Distance from well feet
System Type: C.. -Z F I. v `tam 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.
Permit and °_str ction Authorization.
ID
PERMIT CONDITIONS:
I. Performance:
II. Monitoring.
III. Maintenance:
IV. Operation:
V. Other:
10 1 I)
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_E)
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 Other £'•'i (%l71 Septic Tank:
Subsurface No. of gallons Pump Tank gallons
exact length width of depth of
Drainage Field ditches_ of each ditch feet ditches
feet ditches I inches
French Drain Required: Linear feet
Authorized State Agent_ ~ C f Date j . I
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disaosal, and all conditiinna m rh.
C
I
v
C
U
R.%
U
T4 A
A'
J
e} f
Te
~
~;'Ks-w-k'"^ Y"^.' t_... is ~...:.t.,,.u~ ~I4,~, •.Y Y~h16 .v-
b, Y