OPHTE# cr~-s-1GboJ-, Harnett County Department of Public Health 20781
PERMIT # Operation Permit
New Installation -I& Septic Tank ❑ Repair Nitrification Line El Expansion
PROPERTY LOCATION:
Name: (owner) li> r , LoGs~ 6 SUBDIVISION C+~~o L > s o,~ LOT # -~3
System Installer. t>' -ICA Registration #
Basement with plumbing: ❑ Garage ~K Number of Bedrooms
Type of Water Supply: ❑ Community "IK~ Public ❑ Well Distance from well 1Da feet
System Type: 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.
uow sprem nm seen mscaneo in compuance with appbcable north t.arohna General Statutes Rules for Sewage Treatment and Disposal and all conditions of the
sOQ
30
t S" st-r~c~L
tutAdim,'i tf DS D
I R
t ( E
II h
IN
t7 111
Ned s
L, .N L
nrnwr ~nunit~nur
l~4
Permit and construction Authorization.
~ u.nn a.vnvn wn~.
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 property.
Type of system: ❑ Conventional Other C"~M erL Septic Tank: t a bd gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches t of each ditch feet ditches 3 feet ditrhe< inrhot
French Drain Required: line et
Authorized State Agent cLQ> Date 4 Zug