OP RHTE# oo- Harnett County Department of Public Health 2 0 7 6 5
PERMIT # 5,~_~ Operation Permit
6~~ew Installation 43- Septic Tank ❑ Repaipi~[.. Nitrification Line ❑ Expansion
PROPERTY LOCATION:_ N \ 2~
Name: (owner) h Q SUBDIVISION ( 3 R<) LOT # e~7
System Installer: 0- )1 R t V Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ~"ublic ❑ Well Distance from well J22 feet
System Type: • 2 n Oi-✓ T_\ 1;1_~ t, 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.
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
IV. Operation:
V. Other.
maintenance and reporting.
Following are the specifications for the se ge disposals stem on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: l,090 . gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of /
Drainage Field ditches of each ditch J _ feet ditches feet ditches ~'Dt C inrhp~
Authorized State Agent Date O y 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.
French rain Required: Linear feet
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