OPHTEA4 - - Harnett County Department of Public Health 23403
PERMIT Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ oc�
Name: (owner) �°� ,us- �crc„� SUBDIVISION Axs~+o ��"; LOT #
System Installer: i t-- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communi] Public El Well Distance from well t ® O 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.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation cc
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 11201-ine ❑
PWR Line
Following are the specifications for the ewage disposals stem on the above captioned property.
Type of system: El Conventional Other z Septic Tank: t®av gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ' hes '3 of each ditch —7 Q feet ditches feet ditches 6$ "�.® inches
French Drain Required,�. . _ Linear feet
Authorized State Agent 945 Date
1YA- 5--3Lj 1 �-)