OPHTE# O-~' Harnett County Department of Public Health 20631
PERMIT # Operation Permit
New Installation Septic Tank Repair ❑ Nitrification Line `r Expansion
_ PROPERTY LOCATION: wC
Name: (owner)~n SUBDIVISION LOT
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms ~ )I ef-VI~~G c'<<
Type of Water Su ply: ❑ Community ] Public ❑ Well Distance from well ~,,j_ feet
System Type: (bt,,),j( \ 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.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtn171111 WnulllunY
1. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the s ifrcations for the sewage disposal syn on the above captioned property.
Type of system: Conventional 11 Other c €~A'jLS Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch '?7~> feet ditches feet ditches a. , inches
French Drain Required: Linear feet
Authorized State Agent Date 1
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