OPHTE# 1' 3��.� Harnett County Department of Public Health 2
PERMIT # �.'1C�� Operation Permit
New Installation Septic Tank' Nitrification Line El Repair El Expansion
PROPERTY LOCATION:
Name: (owner) _ZYS`Z' ?S \j -Q E 'LS SUBDIVISION \ � .,S—S mt�„—'i LOT # iC
System Installer: moo c Qn,, NN &-L- Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms —5
Type of Water Supply: ❑ Community KPublic ❑ Well Distance from well I Ci® 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.
This system has been installed in compliance with applicable North larolina benerai )tatutes, Rules for )ewage Ireatment and
and all conditions of the
t�c�v F-
{
rtnrttt U)ND111UN):
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NIf yes, see attached sheet for additional operan ct
IV. Operation:
V. Other:
ti
tv �s�n
maintenance and reporting.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captione roperty.
Type of system: El Conventional X Other C. I> ' v G( -- c N'1 Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc es of each ditch d feet ditches 3 feet ditches df�� inches
French Drain Reouired: �.�Linear�ai
Authorized State Agent ` fl Date I M a )