OP RHTE# O ~,J& 1q -7 ( Harnett County Department of Public Health 21 3 8 8
PERMIT # S Operation Permit
ew Installation Septic Tank ❑ Repair R Nitrification Line ❑ Expansion
PROPERTY LOCATION: Y'\ C: ';4.~"+
Name: (owner) c z i>t SUBDIVISION c) - r~ LOT #
System Installer: S1/\ ~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supp ❑ Community EK Public ❑ Well Distance from well feet
System Type: Lno :t2 -C, A-c C 1n n 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.
1 L1%111, WIWI I,VI1J.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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
Following are the specifications for the sewage isposal s tem on the above ca itioned property.
Type of system: ❑ Conventional Other 'vi 1 ft~ - > Septic Tank: gallons Pump Tank: $ gallons
Subsurface No. of y exact length width of depth of ,
Drainage Field ditches ! of each ditch 170 feet ditches feet ditches r inches
French Drain Required: Linear feet
Authorized State Agent 1 t / Date__