OPHTE# 0 ~ - ,'i IOJS Harnett County Department of Public Health 19875
PERMIT Operation Permit
New Installation Septic Tank ❑ Repair ONitrifi(ation Line El Expansion
PROPERTY LO(ATI N: C
Name: (owner) zltin SUBDIVISION "w r? < LOT #
System Installer. 1046 e a }7,,,1, 6)ev. Cam.. Registration #
Basement with plumbing: ❑ Garage ~4 Number of Bedrooms 37
Type of Water S ply: ❑ (ommuni Public ❑ Well Distance from well feet
System Type: Yu!2V 71> Types V and VI Systems expire in S years.
(in accordance with Table V aI Owner must contact Health Department 6 months prior to expiration for permit renewal.
N1 srtem has been installed in comphuce with a*c" North (arolina General Statutes, IWies for Sewage Treatment and Disposal, and al coo60- of die Improvement Permit and (asstnw= "nuboa
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required.? Yes ❑ No
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other.
icons, maintenance and reporting.
Following are the specifications for the se ge disposA syst~em~ on the above ca boned property.
Type of system: ❑ Conventional Other K4Mt the
Size of tank: Septic Tank: L~ 7 gallons Pump Tank: gallons
Subsurface No. of l exact lengtfi width of depth of
Drainage Field ditches- of each ditch 7 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent L, ~~kL5 . Date ' , U