OPHTE# Q'1 Harnett County Department of Public Health 2 0 5 2 9
PERMIT # ~.~707 Operation Permit
X New Installation X Septic Tank ❑ Repair,X Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~x- iv Lv r-Ps
Name: (owner) SUBDIVISION C P.aA~ A q~,S LOT # 34
System Installer: yvJ "E -'yo "'E-' Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _-3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tocn feet
System Type: ~ 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.
inu sprm nas peen mstaneo in compliance with appucawe norm tarouna benerai Statutes Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Constmaion Authorization.
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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.
Following are the specifications for the sewage disposal system on the/above captioned pro erty.
Type of system: ❑ Conventional Other C~o~g Vtv sC, SS Septic Tank: tO c o gallons Pump Tank: gallons
Subsurface No. of exact length CSiB(I WE,,) width of depth of
Drainage Field ditches of each ditch --A,3 C) feet ditches 3 feet ditches a"14 inches
French Drain Required: et
Authorized State Agent ~a 4`1
Date
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