OP RHTE#Harnett County Department of Public Health 2 0 7 6 0
PERMIT # a 3~S Operation Permit
New Installation 99-Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: 2
Name: (owner) SUBDIVISION r !u) C, V) LOT # iQ j
System Installer. - t V Registration #
Basement with plumbing: ❑ Garage ~4"mber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well /(::0 feet
System Type: ~~wy 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, r(onditions Improvement Permit and Construction Authorization.
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DGRMIT rr unITIMIC•
I. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No`~4
If yes, see attached sheet for additional operation(ccoo
IV. Operation:
V. Other:
maintenance and reporting.
Following are the specifications for the %e"
disposal system on the above captioned property.
Type of system: ❑ Conventional Other
Subsurface No. of exact length
Drainage Field ditches of each ditch 7 feet
French Drain Required: Linear feet
Septic Tank: gallons Pump Tank: gallons
width of depth of q
ditches _ 3 feet ditches R'j inches
Authorized State Agent ~ L~) Date Z 7' Q5' j - 0 9'
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