OPHTE# J1- 503 03 it Harnett County Department of Public Health 19971
PERMIT Operation Permit
New Installation 0' Septic Tank ❑ Repair E~ Nitrification Line ❑ Expansion
PROPERTY LOCATION: A'1
Name: (owner) _ N4 SUBDIVISION CZ :A, LOT # I
System Installer. S Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 2-
Type of Water Supply: ❑ Community Public ❑ Well istance from well 1 feet
System Type: Y- r- , 1? ~.y.t t 4 f ~j Types 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.
Ihn tem has been wstaW in compliance with aoc" North (arohna 6erseral Suwtes, Rules W Sew Treaenem and Disposal, and all corditioas of the hnprovement Permit aad (onswoctim Audwriratihac
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PFRMR MN1111TIANt• 1
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 1!K
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other _ -1,'" 0' Size of tank: Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches_ feet ditches incises
french Drain Required: Linear feet
Authorized State Agent
Date