OP RHTE# 07D3-1-lb 'f:--, r1- Harnett County Department of Public Health 19811
PERMIT # ;2- 3 I Operation Permit
New Installation Septic Tank O Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: a 1
Name: (owner) SUBDIVISION - LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ``f
Type of Water pply: ❑ Community ;n. Public ❑ Well Distance from well J feet
System Type: ML-6 1, ~ti"TC.y , d" I" PA Types V and VI Systems expire in S years.
(lo accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
bas has been mstaw in comphwa with qph(Ale North UOhna Gewal Statutes, Auks for Sewage Treatment ad NspasA ad al con(hom of the Improremmt Perms and comtruction Aud*ha ion.
Lt v1 s 1 ~ ~'L
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ocor+rr rnunrrinuc.
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.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ly
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage dispo~theabove property.
Type of system: ❑ Conventional alther Size of tank: Septic Tank: 3 gallons Pump Tank: (090 gallons
Subsurface No. of width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Agent Date I- G -lop