OP RHTE# Harnett County Department of Public Health 21 4 6 7
PERMIT # ~sb-► 2-. Operation Permit
New Installation Septic Tank ❑ Repair'K Nitrification Line ❑ Expansion
nn PROPERTY LOCATION: i" 1 i cartovF-r- E'D
Name: (owner) S 1 PA,4 G.i L b U t IDU2,S 1 H L SUBDIVISION { Ate' o r g o~*+K
System Installer: ~AN~ L w„zg LOT # 1?
~
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3 Registration #
Type of Water Supply: ❑ Community , Public ❑ Well Distance from well 100
S
System Type: feet
S
(in y accordance with Table V a) Types V and VI Systems expire in S years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system hat h- m,toneA f~ ,,..,...r.___ .
PERMIT CONDITIONS:
Performance:
If. Monitoring:
III. Maintenance:
V. Other.
Permit and fonstruction Authorization.
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional >k Other U~t~asHs~ [-2-1
Subsurface ° `^r No. of Septic Tank: %000 gallons Pump Tank: gallons
exact length width of Drainage field ditches 1 of each ditch a C. O feet ditches D depth of
French Drain Required: L, feet feet ditches f inches
lte~r
Authorized State Agent_ N"~-
Date
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.
IV. Operation: