OP RHTE#-0-g JL_ d 1 & X Harnett County Department of Public Health
PERMIT # _0 5-,a :3+5 Operation Permit
20582
(7L-Lew Installatiot /.Septic Tank ❑ Rep*7~4-Aitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) k.%, C SUBDIVISION 7170 LOT # 2
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Sup I : ❑ Community ~ Public ❑ Well Distance from well - feet
System Type: r 44 14 - Types V and VI Systems expire in 5 years.
(In accordance wi Table V a) Ow must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas Deen mstanea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
Aft
MMIT rAwnlTIAAK.
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1. Performance:
11. 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 operatoo c
maintenance and reporting.
Following are the specifications for the sew Be disposal systen on the above captioned property.
Type of system: El Conventional I~ Other t Septic Tank: gallons Pump Tank: gallons
Subsurface No. of ~~~JJJ e~ct length width of depth of
Drainage field ditches _V_ of each ditch feet ditches- feet ditches inches
French Drain Required: linear feet
Authorized State Agent t-- L.~ Date
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