OPHTE# e -S- 43%44 Harnett County Department of Public Health 25088
PERMIT # Operation Permit
New Installation �R Septic Tank � Nitrification Line El Repair 1:1 Expansion
Q PROPERTY LOCh
ATION: xY GQ, Ps rw)P v R9
Name: (owner) SJYL6roa C' vtE�T SUBDIVISION AMY 104LOa LOT # _
System Installer: L fan aj c Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community A Public ❑ Well Distance from well feet
System Type: i'S r. Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
,,is, epmm nu ueeo uouima in mmpnance wan appnraoie noon urmma saenern Wants, nums for aewaxe veatment and nisposal, and all conditions of the IMismement Permit and
Q2051S E_'7_ C sTiMP.v (.0
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation a
IV. Operation:
Other.
maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for the
sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
12, Other N IZ(. C -t N4�
Septic Tank s 00 U gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditched 3
of each ditch I I j feet
ditches feet
ditches � inches
French Drain Reauired:�
\` GoeGrfeet
-�
Authorized State Agent P-G—Ak% Date
11-