OP RFITE# 01-s=~t~7729 Harnett County Department of Public Health 2 0 6 7 7
PERMIT #d s1- Operation Permit
E~ew Installation peptic Tank ❑ Repair a nitrification line ❑ Expansion
p PROPERTY LKATION: 2 /i i I
Name: (owner) .~a„ro n 1~ ,f ; o SUBDIVISION LOT # IYJ
System Installer: I ~A Registration #
Basement with plumbing: ❑ Garage LC 1 umber of Bedrooms
Type of Water Supply: ❑ Community la' Public ❑ Well Distance from well feet
System Type: _ 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.
Ihls 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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DCQMIT rAki A1TIA11C.
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 disposal ystem on the above captlone property.
Type of system: ❑ Conventional [Er Other s , , C V- il Septic Tank: Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 0 feet ditches _ feet ditches inches
French Drain Required:
Linear feet
Authorized State Agent
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