OPHTE At IS -S 35433 Harnett County Department of Public Health 23970
PERMIT # �$� Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SZo"K-Lo SUBDIVISION PAWL, `l�)aw LOT # VIC
System Installer: mater, C—iOWLCq-0�_-aJ Registration #
Basement with plumbing: ❑ Garage'�X Number of Bedrooms 3
Type of Water Supply: ❑ Communist Public E3 Well Distance from well feet
System Type:b 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.
mm system nit Deen Instanea In (amDllNCe wnn Villi(ale norm Lmmma uenerai mamms, nines im
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
QaS
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.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for the
sewage disposal stem on the above captionedproperty.
Type of system:
El Conventional
,s
Ik Other '✓'.r. -P Nu LZ �t.�w
Septic Tank: t000 gallons Pump Tank: 100 gallons
Subsurface
--� NNo. of
exact length
width of depth of
Drainage Field
ditcc Lt
of each ditch 6 feet
ditches feet ditches inches
French Drain ReDuire&_
linear feet
Authorized State Agent Date 51IL� L
Cl;,�