OPHTE# I r -5-3~ Harnett County Department of Public Health 21336
PERMIT Operation Permit
New Installation, Septic Tank ❑ Repairx Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 1~toy.c~e. ~a~L~GA Gp~w~fijp~ SUBDIVISION LOT #
System Installer: En-<o M r IFS Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1 b6 feet
System Type: a Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas Deen mstauea in
with applucaole north larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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I. 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 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 X Other `T i a., C C,~k ~ P5 Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches _ of each ditch feet ditches _
French Drain ReQuired: _ ar few
tOO y gallons Pump Tank: gallons
depth of
3 feet ditches I~ L} inches
Authorized State Agent 7 ~ e.Evs Date 3 1 \-7 1) 0
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