OPHTE# O~ Harnett County Department of Public Health 21 0 9 2
PERMIT # Operation Permit
New Installation ~ Septic Tank ❑ Repairt( Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 9o9rw-g t-..c. C~~.e. ,tom SUBDIVISION LOT #
System Installer. L--P.ar'--t S~ >,teV- Registration #
Basement with plumbing ❑ Garage 'Z~K Number of Bedrooms 5
Type of Water Supply: ❑ Community Public ❑ Well Distance from well X00 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.
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Norm larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1 LI1t 111 tVl\VIIIV I\J.
1. Performance:
II. Monitoring:
III. Maintenance:
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 operatio conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage dispose system on the above captioned property.
Type of system: ❑ Conventional X Other t 1AZ C)A PW , Septic Tank: to O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch S feet ditches 3 feet ditches ZLl inches
French Drain Required: _ ti font
Authorized State Agent cc- ,5 Date I t
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