OPHTE#1C, Harnett County Department of Public Health 24309
PERMIT # Qfi 0-M Operation Permit
New Installation ''l Septic Tank Nitrification Line ❑ Repair ❑ Expansion
4(� ry� PROPERTY LOCATION: Ft=sTvs
Name: (owner) F�t_q�Gp r—ye 1 1Fa Q 2 SUBDIVISION LOT #
System Installer. Cp q qEN P 5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms `—f
Type of Water Supply: ❑ Community � Public ❑ Well DistTance —from well 100 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.
�— ... 1. wn.pedna mm appnaoie norm tarouna oenenl atamtes, Ames for Sewage Treatment and Disoosal, and all
PERMIT
I. Performance:
If. Monitoring:
III. Maintenance:
Et3gy LtJ
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ 111,54
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
Permit and Construction
H20Line ❑
PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional A Other Ez VL.o..r Septic Tank: sZQSa gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field din
of each ditch i5o feet ditches 3 feet ditches 1'g^3Zv. inches
French Drain Requir ar feet
Authorized State Agent_ Rb TV Date
)G-S-3�VS