OPHTE# ! ®--S-~_l1-j Harnett County Department of Public Health
PERMIT # Operation Permit 21 8 6 8
N New Installation ~k Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~lwya.l
Name: (owner) ~J y o 4 Co 10 g SUBDIVISION 77V~N ssti ~O i,47-LOT # 9 ~
System Installer: i N,c -vo.as r- Registration #
Basement with plumbing: ❑ Garage \t Number of Bedrooms
Type of Water Supply: ❑ Community ~ Public ❑ Well Distance from well 100 feet
System Type: 1' 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.
mis system nas peen mstaneo in compuance wan appdcame Nortn t.armma uenerai statutes, nutes for sewage treatment and Disposal, and an conditions of the Improvement Permit and Construction Authorization.
PUMll CUNUIIIUNN:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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>]
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other: Qv m4 P.OQC_Z 9v e" ' uo.r C;n (m T_cw~ 4)aLC=
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage dispos system on the above captioned property.
Type of system: El Coven Tonal Other u me ~ o T__ :Z FL o,,,, Septic Tank: TDO Q gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 56 feet ditches feet ditches 9'& inches
French Drain Required: Lin
Authorized State Agent n~'_~~y ~_L-~- Date