OPHTE# ,�-t �� 1 Harnett County Department of Public Health 23028
PERMIT # Operation Permit
New Installation �N Septic Tank Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: 0 u 6-L
Name: (owner) 'b u N L-0 ea,5 L SUBDIVISION \ 1- AtACJ LOT #
System Installer: C.-c sc: c C=, C,o. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communi Public El Well Distance from well 1 b feet
System Type: 11 \ > l b 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.
finis system nas peen instanea in
rtKMII LurtullluNS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
wrtn appucame Nortn taronna ueneral xatutes, nines for
Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
R) a U 1-0 E2 -1�) GZ_
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface o. of
Drainage Field ditches
French Drain Reauired: ea
Pump ❑ Alarm El H2OLine El PWR Line
sewage disposals stem on the above Captioned roperty. _
Other 1't P, Septic Tank: ® gallons Pump Tank: gallons
exact length width of depth of
of each ditch 1 C1 feet ditches feet ditches 'Ali-30 inches
Authorized State Agent 7\N� Date 10 i15
13 -5- 3 �� 1)