OPHTE# cab- 500-t"34 Harnett County Department of Public Health 19887
PERMIT # o-~'j 3 V Operation Permit
11 New Installation * Septic Tank ❑ Repair Nitrification Line ❑ Expansion
2(~~ PROPERTY LKATION: ~
Name: (owner) SUBDIVISION C-0\ o LOT
System Installer. 0. 57~ t 14 d Registration # ~':7A_
Basement with plumbing. ❑ Garage fil-Number of Bedrooms
Type of Water Supply: ❑ Community 'A Public ❑ Well Distance from well feet
System Type: E L r { f> Types Y and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Jim system has been imnned in comowe with ap" Rath Carolina Gew;d Sdmtes. Ades for $ewqe Treatment rd DirsA and al conditions of the knprorement Permit and Comwcdon Audgrintion.
J'
I'Mil LUNUII105:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ~j
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Y. Other.
Following are the specifications for the sewage d is al s tem on the above captioned property.
Type of system: ❑ Conventional Odw GS -,"j Size of tank: Septic Tank: O o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of ' /
Drainage Field ditches of each ditch g feet ditches feet ditches Y ~7 inches
French Drain Required: Linear feet
Authorized State Agent U\ Date D ' 01 - J b