OPHTE# o - s^~~ - ► s Harnett County Department of Public Health 19888
PERMIT # ay s Operation Permit
fig-- New Installation 0- Septic Tank ❑ Repair ~d Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION C~ T~~ L U LOT
System Installer. cc( ~2oc Registration #
Basement with plumbing: ❑ Garage [~Oumber of Bedrooms D
Type of Water Supply. ❑ tCommunity 0. Public ❑ Well Distance from well Tf feet
System Type: J-i L -M-2 -
System 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.
nm srx m no Mn msra" m compuna swm appbcanse north L"" wwal
ccowtr rnunsrtnuc.
Stuutn, Wks (a Sewage ire~hnent >nd
r~
X
67
7c
and aM corAhm of the
aproremem Permit aid Construction Audtoriz9on.
'6J
~ f
4,,a
X _
1. Performance
II. Monitoring.
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Auk .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operatio c ditions, maintenance and reporting
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 1 Other k-- , C 1 11 _ Size of tank: Septic Tank: 100-7, gallons Pump Tank: gallons
Subsurface No. of exact length width of 3 depth of
Drainage field ditches of each ditch J feet ditches ~ feet ditches i.rh~
French Drain Required: Linear feet
Authorized State Agent Date
i~