OPHTE#_ji(�"ar 1403Harnett County Department of Public Health 24574
PERMIT # aL°1yl Operation Permit
New Installation ". Septic Tank �K Nitrification Line ❑ Repair ❑ GExpansior
r PROPERTY LOCATION: SYlEg1FFz71soa02a Q
Name: (owner) y Rtin�cwU�ti �icL�sTt (: SUBDIVISION LOT #
System Installer: lfF_u ow ho Registration #
Basement with plumbing: ❑ Ganga Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 'T1s ( Types Y 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.
�1,13 ,r,,.m lo, ueeo msraneo in mmpnana wan applicable Borth Carolina General Statute, Rules for Sewaee Treatment and
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
{' (1-0 e 0SCD
and all wnditiom of
s*+ON Yuji
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.
Permit and
❑ D -Box
❑ Pump ❑
Alarm ❑
F120Line ❑ PWR Line
Following are the specifications for
the sewage disposallssYstem on the above captioned property.
Type of system: El Conventional
Other C. Z 4'tdW
Septic Tank: 'C ia'
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage field ditches
—�
li of each ditch feet
ditches
feet ditches �_ inches
French Drain ReauiredL
Law Gob
Authorized State Agent ,,,A5 Date 3
`ft
Ilk
x ; 3 �ff