OP RHTE# j S~ 1X5~y Harnett County Department of Public Health 19972
PERMIT Operation Permit
New Installation 44 Se tic Tank ❑ Repair ~ Nitrification Line ❑ Expansion
bey- PROPERTY LOCATION:} \ ~
Name: (owner) C cif. SUBDIVISION C-AnI -v t LOT # 2
System Installer. 4 Q2Ck,._)n Registration #
Basement with plumbing ❑ Garage 91 Number of Bedrooms _3_
Type of Water S ply: ❑ Community 9 Public ❑ Well Distance from well _f`-3 feet
System Type: q LET S Types Y and VI Systems expire in 5 years.
(In accordance with Table Y al Owner must contact Health Department 6 months prior to expiration for permit renewal.
V. Other.
Following are the specifications for the se ge dispo system,~o' on th above captioned property.
Type of system: ❑ conventional Zther JdAca L t1 Size of tank: Septic Tank: /;')D J gallons Pump Tank: J gallons
Subsurface No, of exact length width of depth of ~j
Drainage field ditches_ of each ditch c c~ l feet ditches _ feet ditches U inches
trench Drain Required: linear feet -
Authorized State Agent Date 7 0
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: