OPHTE# !t~ - S-- Z3 8 ?2 Harnett County Department of Public Health 21313
PERMIT # Operation Permit
0" New Installation Z" Septic Tank ❑ Repair P Nitrification Line ❑ Expansion
PROPERTY LOCATION:- kr .
Name: (owner) ~Q ltrS SUBDIVISION
T~ar G F~ g LOT # System Installer
Registration #
Basement with plumbing: ❑ Garage C+"Humber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well
System Type: (j feet
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 cmmnlianrc with -r„u. u,..,L _ .
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
Permit and Construction Authorization.
V. Other. Tit
Following are the specifications for the sew dispo I system o the above ca tioned property.
Type of system: ❑ Conventional Other Q~^
J' C C `'X77-' Septic Tank: /(X C)
Subsurface No. of _ gallons Pump lank: gallons
exact length width of depth of
Drainage Field ditches of each ditch 02
feet ditches feet ditches 27 - 1cg inches
French Drain Required: Linear feet
Authorized State
Date 7 %-7/~-VG
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 l~
IV. If yes, see attached sheet for additio al operation conditions, maintenance and reporting,
Operation _ 1-7 I