OPHTE# u 1 - a-'~ 3 Harnett County Department of Public Health 2 0 5 7 7
PERMIT # Y _ Operation Permit
1j New Installation Septic Tank ❑ Repair I> Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION t`~ c LOT #
System Installer: 0 . S J _(Z Registration #
Basement with plumbing: ❑ Garage '54 Number of Bedrooms 3
Type of Water SvTply: ❑ Community 4 Public ❑ Well Distance from well ~J> feet
System Type: q, Z Ir 1 x.3 171 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.
This system has been installed in compliance with applicable North (arolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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rEM111 LVMUIIIV113:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
IV. Operation:
V. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation cc
maintenance and reporting.
Following are the specifications for the sew ge disposal system on the bove captioned property.
Type of system: ❑ Conventional N"ther ~ - -L ~ I ) Septic Tank: J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of `
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Agent Date
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