OP RRNTE# n-7- s- ✓W, e/Z Harnett County Department of Public Health 2 0 5 3 2
PERMIT # 0?q Operation Permit
(?New Installation 2"Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATIO : 7'~:pp kd 1-lc 3,5-
Name: (owner) s C-" SUBDIVISION /1!:VW-d Cs LOT # S~
System Installer: - Iv,,r- ,tea ;,-cla Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community VPublic ❑ Well Distance from well feet
System Type: 71-7_ C- 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.
Ims 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.
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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 specifications for the sews disposals stem on t e above captioned property.
Type of system: ❑ Conventional Other Z F/a W Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch -2 9~-X- feet ditches 3 feet ditches l).- /B inches
trench Drain Required: Linear feet
Authorized State Agent / • Date
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