OPHTE#o~j -5-a LEI Harnett County Department of Public Health 21 3 5 2
PERMIT # Operation Permit
New Installation '19 Septic Tank ❑ Repair_( Nitrification Line ❑ Expansion
PROPERTY LOCATION: Hooter
Name: (owner) l~c.EeJC~ 1~os c SUBDIVISION PFrt~~s~.r•ors ~~L~S LOT # 1~,
System Installer'TES,Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms y
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1O a feet
System Type: 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.
ima srstem nas peen mssaneo in
with applicable north tarobna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization,
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1. Performance:
11. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional opera on conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the abovf captioned pr rty.
Type of system: ❑ Conventional Other L,~~a IS~T 0 ~c > Septic Tank: 1160 4 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches- of each ditch feet ditches- feet ditches 1 inches
French Drain Required:~\ \ Linear feet
Authorized State Agent ~w 'v ~L , = Date _3 ~~~~16