OPHTE#~~- Harnett County Department of Public Health 21 181
PERMIT #Operation Permit
`J~4--New Installation ~ptic Tank (7T Repair is frification line 0 Expansion
PROPERTY LOCATION:
!J t ,~~s
Name: (owner) J
e E- > SUBDIVISION LOT #
System Installer: r r ~r Registration #
Basement with plumbing: ❑ Garage<~-Number of Bedrooms
Type of Water S ply: ❑ Community ;k2yblic ❑ Well Distance from well Vfeet
System Type: f j t-1 C '%-L' 'r 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditiom of the Improvement Permit and Construction Authorization.
r t
-
7- w r
PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Wo
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: 1'j Z L, k ~ C le C L K R- 15-M
OL4o 1 AjaaM ch~%
V. Other
Following are the specifications for the sewa a dispos system on the above captioned property.
Type of system: ❑ Conventional FOther _ L/Ik: I_ f , - t1^ t-( (fnnr-~j ~'I Septic Tank: n3 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 (St L~ Date j
Y Y
WY 4 .
~ttt
F Y
A fir.,
f
9r
r
1 ~
r
-M
tiff
if Mtn
4 sit,
~
asM.
. +I
Mdl
MWAO
.--1 2w