OPHTE# Harnett County Department of Public Health 2 0 7 3 8
PERMIT # j2.S 3q Operation Permit
New InstallationC~Septic Tank ❑ Repairer, Nitrification Line ❑ Expansion
PROPERTY LOCATION: I z)-
Name: (owner) Q~~')J SUBDIVISION A - c LOT #
System Installer
Registration #
Basement with plumbing. ❑ Garage ` Z Number of Bedrooms 3
Type of Water Sup&: ❑ Community 1W Public ❑ Well Distance from well of feet
System Type: Gam. P 14 ..4,; (s t- q 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.
finis system has peen 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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PERMIT rnNnlTlANC•
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 2r
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
following are the specifications for the sewage disposaj stem on the above captioned property.
Type of system: ❑ Conventional /-49-.Other - c k 4 Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches fePr dirrhnc i.A..
French ram Required: linear feet
Authorized State Agent Date
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