OP RHTE# o f - jo--- Harnett County Department of Public Health 2 0 7 5 9
PERMIT # Operation Permit
Chew Installation ~-Septic Tank ❑ Repair< Nitrification Line ❑ Expansion
PROPERTY LOCATION: //zr
Name: (owner) C! SUBDIVISION ~✓t~~T 6»~~ LOT #
System Installer: Q Ji i1z, zk~/,1 Registration #
Basement with plumbing: ❑ Garage t~i-Number of Bedrooms 3
Type of Water Supp ❑ Community X Public ❑ Well Distance from well feet
System Type: 2 9:I -9~✓ j 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.
ims synem nas oeen mstanea in compuance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No D
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewa a disposal s in y~tg 1 on the ` ove captioned property.
Type of system: ❑ Conventional Other SS l
Subsurface No. of exact length
Drainage Field ditches , of each ditch feet
Septic Tank: gallons Pump Tank: gallons
width of depth of f
ditches _S feet ditches ! 6'0 inches
French Drain Required: Linear feet
Authorized State Agent Date 9
4'7' 0
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Permit and Construction Authorization.
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