OPHTE# O-► -L,o 1 ~5 t DD ' Harnett County Department of Public Health 19906
PERMIT # Operation Permit
JS-- New Installation 12~ Septic Tank ❑ Repair p Nitrification Line ❑ Expansion
PROPERTY LOCATION: C Z
Name: (owner) s n SUBDIVISION f, w r. a., LOT #
System Installer. 2 - X - 5 c rangy S, 41 pc.._ Cb (tey G- I LA-Registration #
Basement with plumbing ❑ Garage ?CL Number of Bedrooms 3
Type of Water Su ply: ❑ Community 'J Public ❑ Well Distance from well 5 feet
System Type: 7- 2 F t D.,' l-~t d: 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.
Ns "em ha been imWW in compliance with appiable Rath Carolina General Statutes, Wes for Sewage Tramiew and Dispose, and all con6tiens of die hnprarement Permit and ComtrucdO kdarixauon
r
t~
r'tftrltl cunutf UNY
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other. _
Subsurface system operator required? Yes ❑ No 16
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Y. Other.
Following are the specifications for the see disposal sys em on the above captioned property.
Type of system: ❑ Conventional Other Z. I R Size of tank: Septic Tank: gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch ~ 1( o feet ditches 3 feet ditches t5 -J inches
French Drain Required: linear feet
Authorized State Agent Date 0~