OPHTE# � C� Harnett County Department of Public Health
PERMIT # Operation Permit 2
New Installation '*K Septic Tank X Nitrification Line El Repair El Expansion
PROPERTY LOCATION: C.o9;e ®p
Name: (owner) _ '� bu i i.-flt�sL5 1 c. SUBDIVISION'4 L.- Nn!D\A Q, �a , H 5�,�,t., IN LOT # 1SG
System Installer: �,�ct,c•t�z Registration #
Basement with plumbing: ❑ Garage "X Number of Bedrooms S
Type of Water Supply: ❑ Community >� Public ❑ Well Distance from well )00 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal jystem on the above captioned- operty.
Type of system: ❑ Conventional >I Other 1�i�r�$ C�� Septic Tank: 1' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field tches i of each ditch feet ditches .3 feet ditches i8 "s'� inches
French Drain Required: inear feet
Authorized State Agent Date
1`3- 5 _ 32.Orl (t,