OPHTE#oj-5-1~14g3 Harnett County Department of Public Health 19668
PERMIT # a3°lCO Operation Permit
New Installation '1K Septic Tank ❑ Repair b~ Nitrification Line ❑ Expansion
PROPERTY LOCATION: NGa,A 0
Name: (owner) SLc~-yT ~ "N CUTT SUBDIVISION LOT # _
System Installer. D-r, s S-cci~c,u,.~9 Registration #
Basement with plumbing: ❑ Garage 'fk Number of Bedrooms _ 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: Types Y and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Other. 5w„~,,,r, P~ e M C PQeavvey PIR-16(L I INsv,L, t~; ~o>J
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: R Conventional ❑ Other Size of tank: Septic Tank: SCC tO gallons Pump Tank: gallons
Subsurface !~UAek exact length width of depth of
Drainage field of each ditch feet ditches feet ditches ~inches
french Drain Required: feet
Authorized State Agent yl' Rs Date
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: