OP RHTE# C,` G _Wai. Harnett County Department of Public Health
PERMIT # �` Operation Per It 2 b 12
Ltd' New Installation Septic Tank ❑ Nitrification Line erRepair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms, P
Type of Water Supply: El Community El Public Distance from well Public ee
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This 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
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule ,1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 'WO-
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ h/ Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s on the Bove captioned property.
Type of system: El Conventional 5�KOther , t - �^ 'f Septic Tank: 1 gallons Pump Tank: gallons
Subsurface No. of exact ngth i width of depth of
Drainage Field ditches of each ditch t1 feet ditches feet ditches d°-- r tP inches
French Drain Required: Linear feet
A
Authorized State Agent �-° Date C�- '